Clinical Manifestations and Presentation of Diseases — MCQs

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

Question 351: Commonest manifestation of Grawitz's tumor in males is

A. Secondary deposits
B. Pathological fracture
C. Hematuria (Correct Answer)
D. Rapidly developing varicocele

Explanation: ***Hematuria*** - **Grawitz's tumor**, also known as **renal cell carcinoma (RCC)**, commonly presents with macroscopic or microscopic **hematuria** due to tumor invasion of the collecting system [1]. - While other symptoms can occur, **painless hematuria** is often the primary and most frequently observed symptom, leading to medical evaluation [1]. *Secondary deposits* - While **metastasis** is common in RCC, especially in advanced stages, it usually occurs later in the disease progression [1]. - Patients often present with local symptoms like **hematuria** before widespread secondary deposits become the predominant manifestation [1]. *Pathological fracture* - **Pathological fractures** are a manifestation of **bone metastasis**, which is a secondary deposit. - This symptom implies advanced disease and is not typically the initial or most common presentation of Grawitz's tumor. *Rapidly developing varicocele* - A rapidly developing **left-sided varicocele** can be a sign of RCC, specifically due to **renal vein obstruction** by the tumor or thrombus. - However, this is a less common initial presentation compared to **hematuria**, which directly reflects tumor involvement of the kidney's excretory system.

Question 352: Smoking is not a risk factor for which of the following conditions?

A. Lung carcinoma
B. Osteoporosis
C. Nonunion of bones
D. Sickle cell disease (Correct Answer)

Explanation: ***Alzheimer's disease*** - While various lifestyle factors impact **cognitive decline**, smoking is not directly linked as a primary risk factor for Alzheimer's disease [4]. - The most significant risk factors include **age**, genetics, and coexisting conditions like **cardiovascular disease**. *Lung carcinoma* - Smoking is the **leading risk factor** for lung cancer, responsible for the majority of cases [1][3]. - It causes significant genetic mutations leading to tumor formation in lung tissues [1]. *Osteoporosis* - Smoking has been shown to **negatively affect bone density** and is associated with increased risk of osteoporosis. - It can reduce estrogen levels in women, further contributing to **bone loss**. *Nonunion of bones* - Smoking is a known risk factor for impaired healing, leading to **nonunion** following fractures [2]. - It adversely affects blood flow and oxygen supply to healing tissues, which are critical for bone repair [2].

Question 353: Osborne waves in an ECG are seen in

A. Hypothermia (Correct Answer)
B. Hypokalemia
C. Hypothyroidism
D. Hypocalcemia

Explanation: ***Hypothermia*** - **Osborne waves**, also known as **J waves**, are characteristic ECG findings in **hypothermia**, appearing as a hump or positive deflection at the junction between the QRS complex and the ST segment. - They become more prominent as the **body temperature drops**, reflecting delayed ventricular repolarization [2]. *Hypokalemia* - Hypokalemia is associated with **U waves** on the ECG, which are typically small deflections following the T wave, not Osborne waves [1]. - Other ECG changes include **flattened T waves** and **ST-segment depression**. *Hypothyroidism* - Hypothyroidism can lead to **sinus bradycardia** and **low voltage QRS complexes** on an ECG. - It does not specifically cause Osborne waves. *Hypocalcemia* - Hypocalcemia primarily manifests as a **prolonged QT interval** on the ECG due to delayed ventricular repolarization. - **Osborne waves** are not a typical finding in hypocalcemia.

Question 354: Superior sulcus tumor of the lungs characteristically presents with:

A. Breathlessness
B. Hemoptysis
C. Pancoast syndrome (Correct Answer)
D. Horner's syndrome

Explanation: ***Pancoast syndrome*** - A **superior sulcus tumor**, specifically a Pancoast tumor, is defined by its characteristic presentation as **Pancoast syndrome**. - This syndrome includes a constellation of symptoms resulting from the tumor's invasion of surrounding structures, such as the **brachial plexus**, **cervical sympathetic chain**, and **vertebral bodies**. *Horner's syndrome* - **Horner's syndrome** is a *component* of Pancoast syndrome, caused by the tumor's invasion of the **cervical sympathetic chain**. - While it's a key feature, it doesn't encompass the entire clinical presentation of a superior sulcus tumor, which also includes shoulder and arm pain due to brachial plexus involvement. *Breathlessness* - **Shortness of breath** is a general symptom of many lung conditions, including central lung tumors [1], but it is **not characteristic** of a superior sulcus tumor's typical presentation. - Superior sulcus tumors are located peripherally at the lung apex and often present with local invasive symptoms rather than respiratory distress unless very advanced [2]. *Hemoptysis* - **Hemoptysis** (coughing up blood) is more commonly associated with tumors invading central airways or large vessels [1], but it is **not a characteristic initial presentation** of a superior sulcus tumor. - The location of a superior sulcus tumor in the lung apex makes bleeding into the airways less likely as a primary symptom.

Question 355: What is the most typical presentation of gynaecomastia?

A. Gynaecomastia typically presents with breast tenderness.
B. Gynaecomastia typically presents bilaterally. (Correct Answer)
C. Gynaecomastia typically presents with nipple discharge.
D. Gynaecomastia can present unilaterally.

Explanation: ***Gynaecomastia typically presents bilaterally.*** - While it can be unilateral, **bilateral breast enlargement** is the most common presentation of true gynaecomastia, reflecting a systemic hormonal imbalance. - The glandular tissue symmetrically increases in both breasts due to an altered **estrogen-androgen ratio** [1]. *Gynaecomastia typically presents with breast tenderness.* - **Breast tenderness or pain** can be present in gynaecomastia, especially during its early, proliferative phase, but it is not the most typical or defining presentation. - The hallmark is the **presence of glandular breast tissue**, regardless of tenderness [1]. *Gynaecomastia typically presents with nipple discharge.* - **Nipple discharge** is an uncommon symptom in gynaecomastia and, if present, should prompt further investigation for other causes, including malignancy. - Gynaecomastia primarily involves **glandular tissue proliferation**, not secretory activity. *Gynaecomastia can present unilaterally.* - Although gynaecomastia *can* present unilaterally, this presentation is **less common** than bilateral involvement [1]. - Unilateral presentation may also raise suspicion for other conditions, such as **breast cancer or lipoma**, requiring careful differentiation [1].

Question 356: Which of the following is a cause of chronic cough with a noncontributory chest radiograph?

A. Asthma
B. GERD
C. Post nasal drip
D. All of the options (Correct Answer)

Explanation: ***All of the options*** - **Asthma**, **GERD (gastroesophageal reflux disease)**, and **post nasal drip** [1] are all common causes of chronic cough, where the chest radiograph is typically normal or noncontributory. - These conditions are often primary considerations in the evaluation of chronic cough, especially when other more serious causes (like lung cancer or interstitial lung disease) have been ruled out. *Asthma* - **Cough-variant asthma** is a common presentation where chronic cough is the predominant symptom, often exacerbated by exercise, cold air, or allergens. - A chest radiograph in asthma is typically **normal**, as the pathology involves airway hyperresponsiveness andbronchoconstriction rather than structural lung changes visible on plain film. *GERD* - **Gastroesophageal reflux disease (GERD)** can cause chronic cough due to irritation of the tracheobronchial tree by refluxed stomach acid, even in the absence of typical heartburn symptoms. - A chest radiograph in GERD is usually **unremarkable**, as the cough is a reflex response to esophageal irritation, not a direct lung parenchymal or airway disease process. *Post nasal drip* - **Post nasal drip (PND)**, often due to rhinitis or sinusitis [1], is a very frequent cause of chronic cough, as mucus dripping down the back of the throat irritates the cough receptors. - The chest radiograph is typically **normal** in cases of post nasal drip, as the issue originates in the upper respiratory tract.

Question 357: Pinch purpura around the eyelids is one of the most common findings in

A. Primary systemic amyloidosis (Correct Answer)
B. Fabry's disease
C. Porphyria cutanea tarda
D. None of the options

Explanation: ***Primary systemic amyloidosis*** - **Periorbital purpura**, or "pinch purpura" around the eyelids, is a classic and highly suggestive cutaneous manifestation of **primary systemic amyloidosis**, due to the fragility of small vessels infiltrated by amyloid deposits. - This symptom results from minor trauma or even rubbing, causing vessel rupture and extravasation of blood into the surrounding tissue. *Fabry's disease* - Fabry's disease is a **lysosomal storage disorder** characterized by the accumulation of globotriaosylceramide, leading to acroparesthesias, angiokeratomas, and renal/cardiac involvement. - It does not typically present with periorbital purpura but rather with **angiokeratomas** (small, dark red to purple papules), particularly over the lower trunk. *Porphyria cutanea tarda* - This condition is characterized by **photosensitivity**, skin fragility, blistering lesions, and hyperpigmentation, often triggered by sun exposure [1]. - While it affects the skin, it does not typically cause periorbital purpura but rather **vesiculobullous lesions** and increased skin fragility on sun-exposed areas [1]. *None of the options* - This option is incorrect because **primary systemic amyloidosis** is directly associated with pinch purpura around the eyelids.

Question 358: Which of the following are seen in chronic lymphedema?

A. Stemmer's sign
B. Square toes
C. All of the options (Correct Answer)
D. Hyperkeratosis

Explanation: ***All of the options*** - **Chronic lymphedema** leads to significant tissue changes due to persistent fluid accumulation and inflammation, resulting in all the described clinical signs. - The combination of **Stemmer's sign**, **square toes**, and **hyperkeratosis** are classic indicators of advanced lymphedema, marking specific stages of its progression. *Square toes* - **Square toes** are a distinctive feature of chronic lymphedema, occurring due to protein-rich fluid deposition and fibrosis in the dorsum of the foot, specifically the toes. - The fibrosis leads to tissue thickening and hardening, making the toes appear "squared off" rather than rounded. *Stemmer's sign* - **Stemmer's sign** is a hallmark physical finding in lymphedema, defined as the inability to pinch and lift a fold of skin at the base of the second toe or middle finger. - This inability indicates **fibrotic thickening** of the skin and subcutaneous tissue due to persistent lymphatic fluid buildup. *Hyperkeratosis* - **Hyperkeratosis** refers to the thickening of the stratum corneum (outermost layer of the epidermis) and is a common dermatological manifestation of **chronic lymphedema**. - It results from chronic inflammation, impaired lymphatic drainage, and subsequent protein deposition, leading to rough, warty skin texture.

Question 359: What is the leading cause of death in patients with Crohn's disease?

A. Thromboembolic complication (Correct Answer)
B. Sepsis
C. Malignancy
D. Electrolyte disturbance

Explanation: ***Thromboembolic complication*** - Patients with **Crohn's disease** have a significantly increased risk of venous thromboembolism, including **deep vein thrombosis** and **pulmonary embolism**, due to chronic inflammation and hypercoagulability [2]. - This risk is compounded by factors such as immobility, surgery, and certain medications used to treat Crohn's [2]. *Sepsis* - While **sepsis** is a potential complication in Crohn's disease, particularly in cases of bowel perforation or severe infection, it is not the leading cause of death [1]. - Severe inflammation and compromised bowel integrity can lead to bacterial translocation and systemic infection. *Electrolyte disturbance* - **Electrolyte disturbances** can occur due to severe diarrhea, malabsorption, or fistulas in Crohn's disease but are generally manageable with appropriate medical intervention [1]. - They are rarely a direct cause of mortality unless extremely severe and left untreated. *Malignancy* - Patients with Crohn's disease have an increased risk of certain cancers, particularly **colorectal cancer** and **small bowel adenocarcinoma**, but **thromboembolic events** remain the leading cause of death overall [1]. - The risk of malignancy is often related to the duration and extent of inflammation [1].

Question 360: Most common clinical presentation of sarcoidosis is?

A. Pleural plaque
B. Hilar lymphadenopathy (Correct Answer)
C. Pulmonary fibrosis
D. Interstitial calcification

Explanation: ***Hilar lymphadenopathy*** - The most common clinical presentation of **sarcoidosis** is **hilar lymphadenopathy**, often discovered incidentally on chest X-ray [1]. - It is associated with **granulomatous inflammation** within the lymph nodes, which is a hallmark of sarcoidosis [1]. *Pleural plaque* - Typically associated with **asbestosis**, not sarcoidosis; involves localized fibrous thickening of the pleura. - Rarely presents as a predominant feature in sarcoidosis cases. *Interstitial calcification* - While calcification can occur in sarcoidosis, it is not a primary or common presentation; it pertains more to chronic cases. - It may result from granulomatosis, but the initial clinical manifestation is usually hilar lymphadenopathy. *Pulmonary fibrosis* - Pulmonary fibrosis can develop in advanced sarcoidosis but is not the most common initial presentation. - The early stage is characterized more by **inflammation and lymphadenopathy**, rather than fibrosis.

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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