Clinical Manifestations and Presentation of Diseases Practice Questions

Q: Winberger sign is present in -

Rickets. ***Rickets*** - Winberger sign, specifically refers to a **radiolucent band** at the metaphysis often seen in the distal femur, which is a key radiographic feature of **rickets**. - This sign indicates a **defect in mineralization** of the growing bone due to vitamin D deficiency [1]. *Secondary syphilis* - Secondary syphilis presents with a **maculopapular rash**, **lymphadenopathy**, and constitutional symptoms, not bone abnormalities like Winberger sign. - While syphilis can affect bones later in its course (tertiary syphilis), it typically presents as **periostitis** or **gummas**, which are different from Winberger sign. *Tuberculosis* - Tuberculosis primarily affects the lungs but can cause **skeletal tuberculosis** (Pott's disease), characterized by vertebral collapse and cold abscesses. - It does not present with Winberger sign; its bone manifestations are typically destructive lesions or **osteomyelitis**. *Scurvy* - Scurvy, caused by **vitamin C deficiency**, affects collagen formation, leading to **subperiosteal hemorrhages** and impaired bone growth in children. - Radiographic findings include a **scorbutic rosary** and general rarefaction, not specifically Winberger sign.

Q: Odynophagia is

Pain during swallowing. ***Pain during swallowing*** - **Odynophagia** specifically refers to **pain experienced during the act of swallowing**, which can range from mild discomfort to severe pain. - This symptom often indicates inflammation, infection, or structural damage to the esophagus or throat structures involved in swallowing [1]. *Bad odour from mouth* - This symptom is known as **halitosis**, which is unrelated to the sensation of pain during swallowing [2]. - Halitosis is primarily caused by microbial activity in the mouth, certain foods, or underlying medical conditions such as poor oral hygiene or gum disease. *Psychiatric disease* - While psychological factors can sometimes influence somatic symptoms, **odynophagia is a physical symptom** with a direct physiological basis, not a psychiatric disease itself. - Psychiatric conditions might cause globus sensation (a feeling of a lump in the throat) but generally not true pain during swallowing. *Difficulty in swallowing* - Difficulty in swallowing is medically termed **dysphagia**, which is a distinct symptom from odynophagia [2]. - Dysphagia refers to the sensation of food or liquid getting stuck or not passing smoothly, which may or may not be painful [1].

Q: Which of the following symptoms suggests CHF in infants

Diaphoresis with feedings. ***Diaphoresis with feedings*** - **Diaphoresis (sweating)** during feeding is a classic symptom in infants with **congestive heart failure (CHF)** due to the increased metabolic demand and sympathetic activation required for feeding [1]. - Infants with CHF also often exhibit **poor feeding** and **failure to thrive** due to the high energy expenditure associated with their cardiac condition [1]. *Fever* - **Fever** is a general sign of inflammation or infection and is not a specific indicator of **CHF** in infants. - While an infection could exacerbate CHF, fever itself is not a direct symptom of heart failure. *Persistent irritability* - **Persistent irritability** can be a non-specific sign of discomfort or illness in infants, including those with CHF, but it is not a primary or characteristic symptom. - Irritability can arise from many conditions, making it a less precise indicator for CHF. *Cyanosis* - **Cyanosis** (bluish discoloration of the skin) is a sign of **hypoxemia** and is typically seen in infants with **cyanotic congenital heart defects**, not necessarily in all forms of **CHF** [1]. - While some severe forms of CHF can lead to respiratory distress and secondary cyanosis, it's not a universal or early symptom of CHF itself.

Q: All are caused by parvo virus infection except

Encephalopathy. ***Encephalopathy*** - While parvovirus B19 can have neurological manifestations in rare cases, **encephalopathy** is not a typical or commonly recognized direct manifestation of parvovirus infection. - Neurological complications, when they occur, are usually secondary or related to severe anemia/aplastic crisis, rather than a direct encephalitic process. *Gloves and socks syndrome* - This syndrome, characterized by **pruritic maculopapular rash** on the hands and feet, is a known but less common manifestation of **parvovirus B19 infection**. - It often presents with fever, malaise, and can be seen in both children and adults. *Erythema infectiosum* - Also known as **fifth disease**, it is the most common manifestation of **parvovirus B19 infection** [1] in children, characterized by a **"slapped cheek" rash** followed by a lacy rash on the trunk and extremities [1]. - It is usually a benign, self-limiting childhood illness [1]. *Aplastic crisis* - **Parvovirus B19** has a tropism for **erythroid progenitor cells** [1], leading to their lysis and a temporary cessation of red blood cell production. - In individuals with underlying chronic hemolytic anemias (e.g., **sickle cell disease**, **hereditary spherocytosis**), this can precipitate a severe and life-threatening **aplastic crisis** [1].

Q: Ulnar nerve injury results in:

Clawing of fingers. ***Clawing of fingers*** - An ulnar nerve injury, particularly at the elbow, often leads to **paralysis of the interossei muscles** and the **medial two lumbricals**. [1] - This results in **hyperextension at the metacarpophalangeal joints** and **flexion at the interphalangeal joints** of the 4th and 5th fingers (and sometimes 3rd), creating the characteristic claw hand deformity. [1] *Pointing index* - **Pointing index**, also known as the **sign of benediction** or **preacher's hand**, occurs with **high median nerve lesions** affecting the lateral lumbricals and flexor digitorum superficialis. - The patient is unable to flex the index and middle fingers, especially when attempting to make a fist. *Ape thumb deformity* - **Ape thumb deformity** is caused by a **median nerve injury**, specifically affecting the **thenar muscles** (abductor pollicis brevis, opponens pollicis, and superficial head of flexor pollicis brevis). - This paralysis leads to the thumb being pulled laterally and into the same plane as the other fingers, losing its ability to oppose. *Wrist drop* - **Wrist drop** is a classic sign of **radial nerve injury**, which paralyzes the **extensor muscles of the wrist and fingers**. - This prevents the patient from extending their wrist and metacarpophalangeal joints.

Q: Myoglobinuria is associated with which of the following:

All of the options. ***All of the options*** - **Myoglobinuria** can result from various forms of severe muscle damage leading to the release of myoglobin, the common underlying mechanism for all listed conditions. - Conditions like **electrical injury** and **crush injury** directly cause widespread muscle tissue destruction, releasing myoglobin into the bloodstream, while some tumors can indirectly cause muscle breakdown or be associated with paraneoplastic syndromes affecting muscles. [1] *Tumours* - While generally not a primary cause, certain **malignancies** can indirectly lead to **rhabdomyolysis** and subsequent myoglobinuria through various mechanisms. [1] - Examples include paraneoplastic syndromes, tumor lysis syndrome, or direct muscle involvement by metastatic disease. *Electrical injury* - **Electrical current** passing through the body causes direct **thermal and contractile damage** to muscle cells, leading to their rapid breakdown and release of myoglobin. [1] - The severity of myoglobinuria is often proportional to the voltage and duration of electrical exposure. *Crush injury* - **Crush injuries** directly disrupt muscle cell membranes due to **mechanical compression**, leading to the release of intracellular contents, including myoglobin, into the circulation. - This is a well-recognized cause of **rhabdomyolysis** and can result in acute kidney injury.

Q: Which is not a major criteria for the diagnosis of rheumatic fever?

Increased ASLO. ***Increased ASLO*** - An **elevated anti-streptolysin O (ASLO) titer** indicates a recent streptococcal infection [1] and is a **minor criterion** for the diagnosis of rheumatic fever, not a major one. - While essential for diagnosis as evidence of prior infection, it does not represent direct organ involvement or a principal manifestation of the disease. *Arthritis* - **Arthritis** (specifically **migratory polyarthritis**) is a **major criterion** for the diagnosis of rheumatic fever. - It primarily affects large joints and shifts from one joint to another without leaving permanent damage. *Carditis* - **Carditis** (inflammation of the heart, involving the pericardium, myocardium, or endocardium) is a **major criterion** for rheumatic fever [1]. - It is the most serious manifestation, potentially leading to permanent **rheumatic heart disease** [2]. *Subcutaneous nodules* - **Subcutaneous nodules** are firm, painless nodules typically found over bony prominences (e.g., elbows, knees, ankles) and are a **major criterion** for rheumatic fever. - These nodules are a less common but distinct manifestation of the disease.

Q: Following are the indications of cryotherapy

All of the options. ***All of the options*** - **Cryotherapy** is a versatile treatment that can be effectively used for all the conditions listed: **hemoangiomas**, **epistaxis**, and **vasomotor rhinitis**. - Its mechanism involves controlled tissue destruction through freezing, making it suitable for various dermatological and ENT applications. *Hemoangiomas* - **Cryotherapy** can be used for treating certain types of smaller, superficial **hemoangiomas**, especially in locations where other treatments might be more invasive. - The freezing process causes **vascular damage** and thrombosis, leading to the regression of the *vascular lesion*. *Epistaxis* - **Cryotherapy** can be employed to control **epistaxis** (nosebleeds), particularly in cases where **cautery** or packing is less effective or unsuitable. - It works by freezing and destroying the **bleeding vessels** in the nasal mucosa, forming a scab that prevents further bleeding. *Vasomotor rhinitis* - **Cryotherapy** to the **inferior turbinates** can be a treatment option for **vasomotor rhinitis** resistant to medical therapy. - The freezing process causes **mucosal injury** and fibrosis, which can reduce the hyperactivity of the nasal turbinates and alleviate symptoms like chronic *rhinorrhea* and **congestion**.

Q: Allergic salute is seen in -

Allergic rhinitis. ***Allergic rhinitis*** - The **allergic salute** is a characteristic physical finding in allergic rhinitis [1], where individuals repeatedly push their nose upward with their hand to relieve nasal itching and clear obstruction. - This repetitive gesture can lead to a visible transverse crease on the dorsum of the nose, known as the **nasal crease**. *Nasal Myiasis* - **Nasal myiasis** is an infestation of the nasal cavity by fly larvae, causing symptoms like nasal discharge, epistaxis, and local pain. - It does not involve nasal itching that would provoke the "allergic salute" action. *Chronic sinusitis* - **Chronic sinusitis** is a prolonged inflammation of the sinuses, causing facial pain/pressure, nasal obstruction, and discharge. - While it can cause nasal obstruction, it typically doesn't present with the intense nasal itching that would lead to the "allergic salute." *Chronic conjunctivitis* - **Chronic conjunctivitis** is an inflammation of the conjunctiva, primarily affecting the eyes with symptoms like redness, itching, and discharge. - It does not directly affect the nasal passages or provoke nasal symptoms like itching that would result in an allergic salute.

Q: Which of the following are true/false about clinical features of Fat embolism syndrome? 1. Tachypnea 2. Systemic hypoxia may occur 3. Fat globules in urine are diagnostic 4. Manifests after several days of trauma 5. Petechiae in anterior chest wall

All are true. ***All are true*** - **Tachypnea** (1), **systemic hypoxia** (2) [2], **fat globules in urine** (3) [2], **petechiae in the anterior chest wall** (5) [1], and manifestation **after several days of trauma** (4) [1] are all recognized clinical features or associated findings of **Fat Embolism Syndrome (FES)**. - The classic triad of FES includes **respiratory insufficiency**, **neurological symptoms**, and **petechial rash**, which frequently emerge 24-72 hours post-injury [1]. *1, 3, 4, 5 true & 2 false* - This option incorrectly states that systemic hypoxia is false. **Systemic hypoxia** is a common and serious manifestation of **Fat Embolism Syndrome**, often resulting from pulmonary microvascular obstruction [2]. - While other points are correct, the misidentification of hypoxia as false makes this option incorrect. *1, 2, 3, 5 true & 4 false* - This option incorrectly states that FES does not manifest after several days of trauma. **Fat Embolism Syndrome** typically has a delayed onset, occurring **12-72 hours (several days)** after the initial injury [1], [2]. - The delayed presentation is a key diagnostic characteristic distinguishing it from immediate post-traumatic complications. *2, 4 false & 1, 3, 5 true* - This option is extensively incorrect as it falsely identifies both **systemic hypoxia** and the **delayed manifestation** as false. - **Systemic hypoxia** is a hallmark of pulmonary involvement in FES [2], and **delayed onset** is a crucial diagnostic criterion.

Question 1

Winberger sign is present in -

Accepted Answer

Rickets

Answer

Secondary syphilis

Answer

Scurvy

Answer

Tuberculosis

Question 2

Odynophagia is

Accepted Answer

Pain during swallowing

Answer

Bad odour from mouth

Answer

Psychiatric disease

Answer

Difficulty in swallowing

Question 3

Which of the following symptoms suggests CHF in infants

Accepted Answer

Diaphoresis with feedings

Answer

Fever

Answer

Persistent irritability

Answer

Cyanosis

Question 4

All are caused by parvo virus infection except

Accepted Answer

Encephalopathy

Answer

Gloves and socks syndrome

Answer

Erythema infectiosum

Answer

Aplastic crisis

Question 5

Ulnar nerve injury results in:

Accepted Answer

Clawing of fingers

Answer

Pointing index

Answer

Ape thumb deformity

Answer

Wrist drop

Question 6

Myoglobinuria is associated with which of the following:

Accepted Answer

All of the options

Answer

Tumours

Answer

Electrical injury

Answer

Crush injury

Question 7

Which is not a major criteria for the diagnosis of rheumatic fever?

Accepted Answer

Increased ASLO

Answer

Arthritis

Answer

Carditis

Answer

Subcutaneous nodules

Question 8

Following are the indications of cryotherapy

Accepted Answer

All of the options

Answer

Hemoangiomas

Answer

Epistaxis

Answer

Vasomotor rhinitis

Question 9

Allergic salute is seen in -

Accepted Answer

Allergic rhinitis

Answer

Nasal Myiasis

Answer

Chronic sinusitis

Answer

Chronic conjunctivitis

Question 10

Which of the following are true/false about clinical features of Fat embolism syndrome? 1. Tachypnea 2. Systemic hypoxia may occur 3. Fat globules in urine are diagnostic 4. Manifests after several days of trauma 5. Petechiae in anterior chest wall

Accepted Answer

All are true

Answer

1, 3, 4, 5 true & 2 false

Answer

1, 2, 3, 5 true & 4 false

Answer

2, 4 false & 1, 3, 5 true

Clinical Manifestations and Presentation of Diseases — MCQs

Clinical Manifestations and Presentation of Diseases — MCQs

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