Clinical Manifestations and Presentation of Diseases Practice Questions

Q: The most common route of spread in a case of pyogenic liver abscess is:

Haematogenous through portal vein. Haematogenous through portal vein - Pyogenic liver abscesses commonly result from bacterial translocation from the gut, reaching the liver via the portal venous system. - This route accounts for a significant proportion of cases, especially when associated with conditions like diverticulitis or appendicitis. *Hepatic artery* - While possible, spread via the hepatic artery is less common and usually seen in cases of septicemia or endocarditis. - It would imply a more generalized systemic infection rather than a localized abdominal source. *Ascending infection through biliary duct* - This mechanism is characteristic of cholangitis and often leads to multiple small abscesses or a subcapsular collection, not typically a solitary pyogenic liver abscess. - It occurs due to obstruction to biliary flow from stones or strictures. *Local spread* - Local spread can occur from adjacent infected organs like a subphrenic abscess or an infected gallbladder, but it is not the most common route for the initial development of a pyogenic liver abscess. - This typically results in direct extension into the liver parenchyma.

Q: Clinical features of rheumatic fever include all of the following EXCEPT:

ST segment elevation. ***ST segment elevation*** - While **pericarditis**, which can occur in rheumatic fever, may cause **ST segment elevation**, it is not considered a direct or primary clinical feature of the disease itself according to the **Jones criteria**. - **ST segment elevation** is more characteristic of conditions like **myocardial infarction** or benign early repolarization. *Joint pains* - **Polyarthritis** is a major criterion for diagnosing rheumatic fever, often presenting as **migratory polyarthritis** primarily affecting large joints. - The joint pain is typically very responsive to salicylates. *Cardiomegaly* - **Carditis**, a major manifestation of rheumatic fever, can lead to **myocarditis** and **valvular inflammation**, which may result in **cardiac enlargement** (cardiomegaly). - This reflects the significant inflammatory damage to the heart structures. *Increased PR interval* - Prolongation of the **PR interval** on an ECG is a common finding in rheumatic fever, indicating **first-degree AV block** due to inflammation of the conduction system. - This is considered a minor criterion according to the modified Jones criteria.

Q: Aspirin triad is?

Samter's syndrome. ***Samter's syndrome*** - Also known as **aspirin-exacerbated respiratory disease (AERD)** or aspirin triad, this condition is characterized by **asthma**, **nasal polyps**, and a sensitivity to **aspirin** and other NSAIDs [1]. - The symptoms are typically triggered by NSAID ingestion, leading to a severe asthmatic response and rhinosinusitis [1]. *Kartagener's syndrome* - This is a subgroup of **primary ciliary dyskinesia** characterized by the triad of **situs inversus** (organ reversal), chronic sinusitis, and bronchiectasis. - It is a genetic disorder affecting ciliary function, which is unrelated to aspirin sensitivity. *Young syndrome* - This syndrome is characterized by the triad of **bronchiectasis**, rhinosinusitis, and **obstructive azoospermia** in men due to ciliary dysfunction. - It does not involve aspirin sensitivity or nasal polyps as primary features. *Churg-Strauss syndrome* - Now known as **Eosinophilic Granulomatosis with Polyangiitis (EGPA)**, it is a rare autoimmune disease characterized by **asthma**, **eosinophilia**, and **vasculitis**. - While asthma is a feature, the core triad of EGPA involves systemic vasculitis and high eosinophil counts, not nasal polyps or specific aspirin sensitivity.

Q: Gurd test detects:

Fat globules in urine. ***Fat globules in urine*** - The **Gurd test** is a clinical method used to detect the presence of **fat globules in urine**, which can be an indicator of fat embolism [1]. - Presence of **fat droplets in urine** occurs when fat emboli are filtered through the kidneys, suggesting systemic fat embolism [1]. *Fat globules in bone marrow* - The detection of **fat globules in bone marrow** is typically associated with bone marrow aspiration or biopsy findings, not a specific diagnostic test called Gurd test. - While **fat embolism syndrome** can originate from marrow trauma, the Gurd test specifically examines urine [1]. *Fat globules in blood* - **Fat globules in blood** (lipemia) can be detected through various laboratory tests assessing serum lipids or through direct microscopic examination of blood smears, but not with the Gurd test. - The Gurd test focuses on the excretion of fat through the kidneys, not its presence directly in the bloodstream [1]. *Fat globules in sputum* - **Fat globules in sputum** are not a typical diagnostic finding for conditions like fat embolism and would suggest a different pathology, such as aspiration pneumonia with lipid content or pulmonary injury where fat might be coughed up. - The Gurd test is not designed for the detection of fat in respiratory secretions.

Q: A 78 year old man who lives alone and prepares his own food is found to have ecchymotic patches over posterior aspect of his lower extremities. He has haemorrhagic areas around hair follicles, hair are fragmented and splinter haemorrhages are present in nail beds and several hematomas are present in the muscles of arms and legs. PT and CT are normal. This clinical syndrome is most likely due to

Vitamin C deficiency. ***Vitamin C deficiency*** - The constellation of **ecchymotic patches**, **perifollicular hemorrhages** with fragmented hairs, **splinter hemorrhages**, and **muscle hematomas** is classic for **scurvy**, caused by vitamin C deficiency [2]. - Vitamin C is essential for **collagen synthesis**, and its deficiency leads to weakened blood vessel walls and connective tissue, resulting in these bleeding manifestations [2]. *Vitamin A deficiency* - Primarily causes **ocular symptoms** such as **night blindness** and **xerophthalmia**, and can also lead to **hyperkeratosis follicularis** (bumpy skin) [1]. - It does not typically cause the diffuse ecchymoses, perifollicular hemorrhages, or muscle hematomas seen in this patient. *Vitamin K deficiency* - Leads to impaired synthesis of **coagulation factors II, VII, IX, and X**, resulting in prolonged **PT (prothrombin time)** and **aPTT (activated partial thromboplastin time)** [3]. - The patient's normal PT and CT strongly argue against vitamin K deficiency as the primary cause of bleeding [3]. *Pyridoxine deficiency* - Also known as **vitamin B6 deficiency**, it can cause **neurological symptoms** (neuropathy, seizures), **dermatitis**, and **sideroblastic anemia**. - It is not associated with the extensive bleeding and connective tissue manifestations described in this clinical scenario.

Q: Which of the following is a minor criterion for the diagnosis of acute rheumatic fever?

Fever. ***Fever*** - **Fever** is a minor diagnostic criterion for **acute rheumatic fever** (ARF), indicating systemic inflammation [1]. - While non-specific, its presence alongside other criteria supports the diagnosis, particularly in the context of recent streptococcal infection. *Subcutaneous nodules* - **Subcutaneous nodules** are a **major criterion** for ARF, typically firm, painless lumps found over bony prominences. - Their presence indicates more severe, chronic inflammation in ARF. *Carditis* - **Carditis** is a **major criterion** for ARF, referring to inflammation of the heart, which can affect the pericardium, myocardium, or endocardium [1]. - It is the most serious manifestation of ARF, as it can lead to permanent **rheumatic heart disease** [2]. *Chorea* - **Chorea** (specifically **Sydenham chorea**) is a **major criterion** for ARF, characterized by involuntary, jerky movements, often presenting late in the disease course [1]. - It results from inflammation affecting the basal ganglia.

Q: Grey Turner's sign is seen in:

Acute pancreatitis. ***Acute pancreatitis*** - **Grey Turner's sign** is characterized by **flank ecchymosis** (bruising) resulting from retroperitoneal hemorrhage in cases of severe acute pancreatitis [1]. - This sign indicates pancreatic necrosis and hemorrhage, often associated with a **worse prognosis** [1]. *Acute cholecystitis* - Acute cholecystitis primarily presents with **right upper quadrant pain**, fever, and leukocytosis due to gallbladder inflammation, not flank ecchymosis [2]. - **Murphy's sign** (inspiratory arrest on palpation of the right upper quadrant) is characteristic. *Acute hepatitis* - Acute hepatitis involves **liver inflammation** causing jaundice, fatigue, and elevated liver enzymes, but does not cause flank bruising. - It does not present with signs of retroperitoneal hemorrhage. *Acute appendicitis* - Acute appendicitis typically causes **periumbilical pain** that migrates to the right lower quadrant, associated with nausea, vomiting, and fever [2]. - Classic signs include **McBurney's point tenderness** and rebound tenderness, not flank ecchymosis.

Q: Blue sclera is seen in-

Osteogenesis imperfecta. Blue sclera is seen in- ***Osteogenesis imperfecta*** - **Blue sclera** is a classic sign due to the underlying **collagen disorder** where the sclera is thinner, allowing the underlying choroidal vessels to show through. - This genetic disorder is characterized by **brittle bones** and **connective tissue fragility**. *Ehlers-Danlos syndrome* - While it is a **collagen disorder** and can cause **connective tissue laxity**, **blue sclera** is not a primary or common feature. [1] - It often presents with **hyperextensible joints**, **fragile skin**, and easy bruising. [1] *Marfan syndrome* - This is a genetic disorder affecting connective tissue, primarily due to a defect in **fibrillin-1**, but it is not typically associated with **blue sclera**. - Key features include **tall stature**, **long slender limbs (arachnodactyly)**, and **cardiovascular abnormalities** like aortic dissection. *Rheumatoid arthritis* - This is an **autoimmune inflammatory disease** primarily affecting synovial joints and is not associated with **blue sclera**. - Ocular manifestations in rheumatoid arthritis typically involve **scleritis** or **episcleritis**, which are inflammatory conditions of the sclera, not a blue discoloration.

Q: Which of the following conditions can lead to non-traumatic amputation?

Diabetes mellitus. ***Diabetes mellitus*** - **Peripheral neuropathy** and **vascular disease** in diabetes lead to impaired sensation, poor wound healing, and increased risk of infection, often necessitating amputation. - **Diabetic foot ulcers** are a common precursor to amputation, especially when complicated by osteomyelitis or gangrene. *All of the listed conditions* - While other conditions listed can lead to non-traumatic amputation, this option is incorrect as it includes conditions that are less likely or have different mechanisms compared to the more direct and common pathway seen in diabetes. - The question asks for a specific condition that *can* lead to non-traumatic amputation, and while some others might, diabetes is a primary and very common cause. *Leprosy* - **Peripheral nerve damage** in leprosy causes loss of sensation, leading to unnoticed injuries, repeated trauma, and secondary infections, which can ultimately result in auto-amputation or surgical amputation. - While it can lead to amputation, it is primarily due to undetected injuries and subsequent infection rather than direct vascular compromise. *Sickle cell anemia* - **Vaso-occlusive crises** in sickle cell anemia can lead to severe *ischemia* and tissue necrosis, which may necessitate amputation if not managed effectively. - This is a less common cause of non-traumatic amputation compared to diabetes, and usually occurs in severe, recurrent episodes affecting the extremities.

Q: A patient who is a known case of cystic fibrosis comes to the emergency department with a complaint of abdominal pain. He gives a history of similar episodes in the past. Abdominal X-ray and USG were done in the patient after stabilization. The patient is not at risk of which of the following conditions?

Niacin deficiency. ***Niacin deficiency*** - Cystic fibrosis primarily affects **fat-soluble vitamin absorption (A, D, E, K)** due to pancreatic insufficiency. - **Niacin** (Vitamin B3) is a water-soluble vitamin, and its deficiency is not a typical complication of cystic fibrosis unless there are severe, prolonged dietary restrictions. *Vitamin B12 deficiency* - While Vitamin B12 is water-soluble, proper absorption requires **intrinsic factor** and functional ileum, and its malabsorption can occur in CF patients due to **impaired pancreatic enzyme activity** and bacterial overgrowth leading to **bacterial degradation of B12**. - Additionally, chronic pancreatic insufficiency can impact the release of **R-binders** and subsequent B12 absorption [1]. *Neuropathy* - **Neuropathy** can develop in cystic fibrosis patients, particularly due to **Vitamin E deficiency** which is common given the malabsorption of fat-soluble vitamins. - Vitamin E is a crucial antioxidant, and its prolonged deficiency can lead to **neurological damage**, including peripheral neuropathy and ataxia. *Pancreatic carcinoma* - Patients with cystic fibrosis have a significantly **increased risk of developing pancreatic adenocarcinoma** compared to the general population. - This elevated risk is attributed to chronic inflammation and fibrosis within the pancreas.

Question 1

The most common route of spread in a case of pyogenic liver abscess is:

Accepted Answer

Haematogenous through portal vein

Answer

Hepatic artery

Answer

Ascending infection through biliary duct

Answer

Local spread

Question 2

Clinical features of rheumatic fever include all of the following EXCEPT:

Accepted Answer

ST segment elevation

Answer

Joint pains

Answer

Cardiomegaly

Answer

Increased PR interval

Question 3

Aspirin triad is?

Accepted Answer

Samter's syndrome

Answer

Kartagener s syndrome

Answer

Young syndrome

Answer

Churg-Strauss syndrome

Question 4

Gurd test detects:

Accepted Answer

Fat globules in urine

Answer

Fat globules in bone marrow

Answer

Fat globules in blood

Answer

Fat globules in sputum

Question 5

A 78 year old man who lives alone and prepares his own food is found to have ecchymotic patches over posterior aspect of his lower extremities. He has haemorrhagic areas around hair follicles, hair are fragmented and splinter haemorrhages are present in nail beds and several hematomas are present in the muscles of arms and legs. PT and CT are normal. This clinical syndrome is most likely due to

Accepted Answer

Vitamin C deficiency

Answer

Vitamin A deficiency

Answer

Vitamin K deficiency

Answer

Pyridoxine deficiency

Question 6

Which of the following is a minor criterion for the diagnosis of acute rheumatic fever?

Accepted Answer

Fever

Answer

Subcutaneous nodules

Answer

Carditis

Answer

Chorea

Question 7

Grey Turner's sign is seen in:

Accepted Answer

Acute pancreatitis

Answer

Acute cholecystitis

Answer

Acute hepatitis

Answer

Acute appendicitis

Question 8

Blue sclera is seen in-

Accepted Answer

Osteogenesis imperfecta

Answer

Ehlers-Danlos syndrome

Answer

Marfan syndrome

Answer

Rheumatoid arthritis

Question 9

Which of the following conditions can lead to non-traumatic amputation?

Accepted Answer

Diabetes mellitus

Answer

All of the listed conditions

Answer

Leprosy

Answer

Sickle cell anemia

Question 10

A patient who is a known case of cystic fibrosis comes to the emergency department with a complaint of abdominal pain. He gives a history of similar episodes in the past. Abdominal X-ray and USG were done in the patient after stabilization. The patient is not at risk of which of the following conditions?

Accepted Answer

Niacin deficiency

Answer

Vitamin B12 deficiency

Answer

Neuropathy

Answer

Pancreatic carcinoma

Clinical Manifestations and Presentation of Diseases — MCQs

Clinical Manifestations and Presentation of Diseases — MCQs

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