Clinical Manifestations and Presentation of Diseases Practice Questions

Q: What type of fever is a patient with the following temperature charting having?

Intermittent fever. ***Intermittent fever*** - The temperature graph clearly shows periods where the temperature **returns to normal** or below normal levels each day, followed by spikes. - This pattern, where there are significant fluctuations and the temperature touches the baseline, defines an **intermittent fever**. *Continuous fever* - A continuous fever is characterized by sustained elevation of temperature with **minimal fluctuation (less than 1°C)** over 24 hours. - The temperature in this graph shows wide fluctuations and frequently drops to normal, ruling out a continuous pattern. *Remittent fever* - In remittent fever, the temperature fluctuates significantly, but it **does not return to normal** during the course of the day. - The provided charting shows the temperature dropping back to or below the baseline (green dashed line), which is inconsistent with remittent fever. *Pel-ebstein fever* - Pel-ebstein fever is a **recurrent, cyclical fever** characterized by bouts of fever lasting several days or weeks, separated by afebrile periods of similar duration. - This specific pattern is typically associated with **Hodgkin's lymphoma** and is not represented by the daily fluctuations seen in the given chart.

Q: All are possible diagnoses in this patient except:

Cushing disease. ***Cushing disease*** - **Hyperpigmentation** is not a characteristic feature of Cushing disease; instead, patients often present with thin, fragile skin and striae due to **excess cortisol**. - Cushing's disease is caused by an **ACTH-producing pituitary adenoma**, leading to increased cortisol but typically not the prominent melanosis seen here. *Peutz-Jeghers syndrome* - This syndrome is characterized by mucocutaneous pigmentation, typically presenting as **dark brown/blue macules on the lips, buccal mucosa, and around the nostrils and eyes**. - These pigmentations are often accompanied by **gastrointestinal hamartomatous polyps**, which can cause bleeding or obstruction. *Addison disease* - **Hyperpigmentation** of the skin and mucous membranes (especially in sun-exposed areas, pressure points, and palmar creases) is a classic sign of Addison disease due to increased **ACTH stimulating melanocytes**. - This clinical presentation *is consistent* with the image showing darkened fingertips and potentially nail beds. *Ochronosis* - Ochronosis is a rare genetic disorder characterized by the accumulation of **homogentisic acid** in connective tissues, leading to discoloration. - Pigmentation commonly affects the **ears, nose, sclera**, and eventually various other tissues, including nails and teeth, turning them bluish-black.

Q: In a very tall patient with arm span > height, the thumb projects beyond palm when flexed. This sign is known as:

Thumb sign. ***Thumb sign*** - The **thumb sign** (also known as the **Steinberg sign**) is present when the entire distal phalanx of the thumb projects beyond the ulnar border of the hand when the thumb is maximally adducted and the fingers are flexed over it. - This sign is indicative of **arachnodactyly**, often seen in conditions like **Marfan syndrome**, due to increased length of the thumb. *Arachnodactyly* - **Arachnodactyly** refers to abnormally long and slender fingers and toes, sometimes described as "spider fingers." - While the thumb sign is an indicator of arachnodactyly, arachnodactyly itself is a physical characteristic, not the name of this specific sign. *Steinberg sign* - The **Steinberg sign** is actually another name for the **thumb sign**, but the question asks for "This sign is known as," implying a primary recognized name. - While technically correct, "Thumb sign" is generally used interchangeably or as the more descriptive term for this specific maneuver. *Wrist sign* - The **wrist sign** (also known as the **Ghent sign** or **Walker-Murdoch sign**) involves overlapping the thumb and fifth finger around the contralateral wrist. - If the thumb and fifth finger overlap, it indicates increased wrist circumference relative to the patient's size, commonly associated with the long bone length in conditions like **Marfan syndrome**.

Q: The image shows presence of:

Geographical tongue. ***Geographical tongue*** - The image exhibits multifocal, irregularly shaped areas of **erythema** (redness) on the dorsal surface of the tongue, surrounded by a distinct **white or yellowish border**. This classic presentation is characteristic of geographical tongue, also known as benign migratory glossitis. - The alternating areas of **atrophied filiform papillae** (red areas) and normal or hyperkeratotic papillae (white borders) contribute to its map-like appearance. *Leukoplakia* - Leukoplakia characteristically presents as **white patches or plaques** on the mucous membranes that cannot be scraped off. - It does not typically show the distinct red and white migratory pattern seen in the image. *Black hairy tongue* - Black hairy tongue is characterized by the **elongation and discoloration of the filiform papillae**, leading to a dark, furry appearance on the dorsal surface of the tongue. - The image clearly shows a red and white pattern, not a dark, hairy texture. *Median rhomboid glossitis* - Median rhomboid glossitis usually presents as a **red, rhomboid-shaped, depapillated area** in the midline of the dorsal surface of the tongue, anterior to the circumvallate papillae. - Unlike the image, it does not display the migratory, irregular shapes and defined white borders typical of geographical tongue.

Q: All are true about the clinical sign elicited except:

Is as sensitive as USG for detection of ascites. The image displays the puddle sign, a physical examination technique used to detect ascites. The patient is positioned on all fours, and a stethoscope is placed over the dependent part of the abdomen while the examiner lightly percusses the abdomen from a higher point. The sound heard through the stethoscope changes from a dull thud (over fluid) to a clearer resonance (over gas-filled bowel) as the fluid level is crossed. This question asks to identify the incorrect statement about the puddle sign. ***Is as sensitive as USG for detection of ascites*** - The **puddle sign** is a clinical bedside test for ascites, but its sensitivity is lower than that of **ultrasonography (USG)**. - USG can detect as little as 50-100 mL of ascitic fluid, whereas the puddle sign typically requires a larger volume. *Used for detection of as little as 120 ml of fluid* - While traditionally taught that the puddle sign can detect small amounts, studies show it is less sensitive than imagined and often requires more fluid than 120 ml for reliable detection. - For detecting 120 mL of fluid, **ultrasonography** would be a more sensitive and reliable method than the puddle sign. *Sign is false positive in massive splenomegaly* - The **puddle sign** relies on the movement of fluid. In cases of **massive splenomegaly**, the spleen can displace bowel loops and produce an area of dullness that mimics fluid accumulation, potentially leading to a false positive. - The large spleen effectively acts like a "puddle" itself, preventing the normal shift of bowel sounds. *Can be elicited by ausculto-percussion method* - The description of the puddle sign involves listening with a stethoscope while percussing, which is precisely the **ausculto-percussion** method. - This technique helps to identify the shift in dullness or resonance over fluid-filled areas.

Q: A 43-year-old diabetic male presents with cough, fever, weight loss, with loss of appetite since 2 months. CT scan shows:

Cavity. ***_Cavity_*** - The CT image clearly shows a complex lesion with a **thick, irregular wall** and a **gas-fluid level** within the lung parenchyma, which is characteristic of a cavity. - The patient's symptoms of **cough, fever, and weight loss over two months**, especially in a diabetic individual, are highly suggestive of a *chronic cavitating pulmonary process*, such as **pulmonary tuberculosis** or a **necrotizing pneumonia/abscess**. *Bronchiectasis* - Bronchiectasis is characterized by **irreversible dilation of the bronchi**, often seen as "tram tracks" or "signet ring" signs on CT, which are not the predominant finding here. - While patients with bronchiectasis can have cough and recurrent infections, the distinct **cavitation** seen on the image is not a primary feature of bronchiectasis itself. *Chronic bronchitis* - Chronic bronchitis is a clinical diagnosis defined by **chronic productive cough for at least three months a year** for two consecutive years, and is primarily a disease of the airways, not typically associated with focal cavitary lesions on CT scans. - The CT findings of a distinct cavitary lesion are not consistent with the imaging features of chronic bronchitis, which usually show **bronchial wall thickening** and **mucous plugging**. *Consolidation with synpneumonic effusion* - **Consolidation** refers to lung tissue filled with fluid or exudate, appearing as opacification, and **synpneumonic effusion** is pleural fluid accompanying pneumonia. - While these can cause cough and fever, the striking feature in the image is the **central lucency with a distinct wall** indicative of a cavity, rather than homogeneous consolidation or a simple pleural effusion.

Q: Which of the following statements is correct about the test being performed on the patient? (AIIMS May 2016)

Root value is L2, L3, L4. ***Root value is L2, L3, L4*** - The image depicts the elicitation of the **patellar reflex**, also known as the **knee jerk reflex**. - This reflex primarily tests the integrity of the **femoral nerve** and the spinal cord segments **L2, L3, and L4**, which are the main nerve roots involved in the patellar reflex arc. *Reflex is always brisk in case of motor neuron disease* - In **upper motor neuron (UMN) lesions**, reflexes are typically **brisk** or hyperactive due to loss of inhibitory control. - However, in **lower motor neuron (LMN) lesions** (which can occur in certain forms of motor neuron disease like progressive muscular atrophy), reflexes are **diminished** or absent. *The examiner is doing the test wrongly* - The examiner appears to be performing the patellar reflex test correctly, striking the **patellar tendon** with a reflex hammer. - The patient's leg is positioned to allow for a free swing, which is ideal for observing the reflex. *Reflex is always absent in case of peripheral nerve disease* - **Peripheral nerve disease** (neuropathy) often leads to **diminished or absent reflexes** because it affects the afferent or efferent limbs of the reflex arc. - However, the severity varies, and some neuropathies may cause only mild reduction, and early stages might not show complete absence.

Q: Which of the following are considered aetiological factors for Adenocarcinoma oesophagus? I. Barrett's oesophagus II. Gastro-oesophageal reflux III. Obesity IV. Alcohol intake Select the correct answer using the code given below :

I, II and III. ***I, II and III*** - **Barrett's oesophagus** is a known precursor to **oesophageal adenocarcinoma** due to **metaplasia** of the squamous epithelium to columnar epithelium with goblet cells, increasing the risk of dysplasia and subsequent cancer [1]. - **Gastro-oesophageal reflux disease (GERD)** is a major risk factor, as chronic reflux of gastric acid can lead to inflammation, oesophagitis, and eventually **Barrett's oesophagus** [1]. - **Obesity** is strongly associated with an increased risk of **oesophageal adenocarcinoma**, primarily through its links to **GERD** and increased intra-abdominal pressure [1]. *I, II and IV* - This option correctly identifies **Barrett's oesophagus** and **gastro-oesophageal reflux** as risk factors. - However, **alcohol intake** is not as strongly linked to **oesophageal adenocarcinoma** as it is to squamous cell carcinoma of the oesophagus [1]. *II, III and IV* - This option correctly identifies **gastro-oesophageal reflux** and **obesity** as risk factors. - However, it incorrectly includes **alcohol intake** as a primary risk factor for **adenocarcinoma**, and incorrectly omits **Barrett's oesophagus**, which is a direct precursor. *I, III and IV* - This option correctly identifies **Barrett's oesophagus** and **obesity** as risk factors. - However, it incorrectly includes **alcohol intake** and omits **gastro-oesophageal reflux**, which is a fundamental link between obesity, Barrett's, and adenocarcinoma.

Q: Which one of the following is a cause of exudative ascites ?

Peritoneal malignancy. ***Peritoneal malignancy*** - **Malignant cells** can directly or indirectly increase capillary permeability and fluid production within the peritoneal cavity. - This leads to a **high protein content** in the ascitic fluid, characteristic of exudate [1]. *Nephrotic syndrome* - Causes **transudative ascites** due to severe **hypoalbuminemia**, leading to decreased plasma oncotic pressure [1]. - The liver is healthy, and there is no direct inflammation or increased capillary permeability in the peritoneum. *Portal vein thrombosis* - Results in **increased hydrostatic pressure** within the portal circulation, leading to the transudation of fluid into the peritoneal cavity. - The ascitic fluid typically has a **low protein content** as it's a transudate, not an exudate [1]. *Congestive cardiac failure* - Leads to **increased systemic venous pressure** and consequently elevated hepatic sinusoidal and splanchnic capillary pressures [1]. - This causes **transudative ascites** with low protein content due to passive fluid leakage rather than inflammation or direct vascular damage [1].

Question 1

What type of fever is a patient with the following temperature charting having?

Accepted Answer

Intermittent fever

Answer

Continuous fever

Answer

Remittent fever

Answer

Pel-ebstein fever

Question 2

All are possible diagnoses in this patient except:

Accepted Answer

Cushing disease

Answer

Peutz-Jehgers syndrome

Answer

Addison disease

Answer

Ochronosis

Question 3

In a very tall patient with arm span > height, the thumb projects beyond palm when flexed. This sign is known as:

Accepted Answer

Thumb sign

Answer

Arachnodactyly

Answer

Steinbert sign

Answer

Wrist sign

Question 4

The image shows presence of:

Accepted Answer

Geographical tongue

Answer

Leukoplakia

Answer

Black hairy tongue

Answer

Median rhomboid glossitis

Question 5

All are true about the clinical sign elicited except:

Accepted Answer

Is as sensitive as USG for detection of ascites

Answer

Used for detection of as little as 120 ml of fluid

Answer

Sign is false positive in massive splenomegaly

Answer

Can be elicited by ausculto-percussion method

Question 6

A 43-year-old diabetic male presents with cough, fever, weight loss, with loss of appetite since 2 months. CT scan shows:

Accepted Answer

Cavity

Answer

Bronchiectasis

Answer

Chronic bronchitis

Answer

Consolidation with synpneumonic effusion

Question 7

Which of the following statements is correct about the test being performed on the patient? (AIIMS May 2016)

Accepted Answer

Root value is L2, L3, L4

Answer

Reflex is always brisk in case of motor neuron disease

Answer

The examiner is doing the test wrongly

Answer

Reflex is always absent in case of peripheral nerve disease

Question 8

Which of the following are considered aetiological factors for Adenocarcinoma oesophagus?
I. Barrett's oesophagus
II. Gastro-oesophageal reflux
III. Obesity
IV. Alcohol intake

Select the correct answer using the code given below :

Accepted Answer

I, II and III

Answer

I, II and IV

Answer

II, III and IV

Answer

I, III and IV

Question 9

Which one of the following statements is correct for subcutaneous nodules in Rheumatic fever?

Accepted Answer

They typically appear more than 3 weeks after onset of other clinical manifestations

Answer

They are present over flexor aspect of forearm

Answer

They are painful tender nodules

Answer

The usual size of these nodules is 3-5 cm

Question 10

Which one of the following is a cause of exudative ascites ?

Accepted Answer

Peritoneal malignancy

Answer

Nephrotic syndrome

Answer

Portal vein thrombosis

Answer

Congestive cardiac failure

Clinical Manifestations and Presentation of Diseases — MCQs

Clinical Manifestations and Presentation of Diseases — MCQs

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