Clinical Manifestations and Presentation of Diseases Practice Questions

Q: Which of the following is not true about polymyositis

Ophthalmoplegia. ***Ophthalmoplegia*** - **Polymyositis** primarily affects **proximal limb and trunk muscles**, sparing the extraocular muscles [1]. - **Ophthalmoplegia**, or paralysis of the extraocular muscles, is not a typical feature of polymyositis and would suggest a different neuromuscular disorder. *Limb girdle weakness* - **Polymyositis** characteristically causes **symmetric proximal muscle weakness**, affecting the muscles of the shoulder (pectoral) and hip (pelvic) girdles [1]. - Patients typically present with difficulty rising from a chair, climbing stairs, or lifting objects overhead [1]. *Para-neoplastic syndrome* - Polymyositis, like other inflammatory myopathies, can be a **paraneoplastic syndrome**, particularly in older adults [2]. - It is important to screen for underlying malignancies in patients diagnosed with polymyositis, especially if they have atypical features or are above a certain age [2]. *Spontaneous discharge in EMG* - **Electromyography (EMG)** in polymyositis typically shows findings of muscle irritation and degeneration, including **spontaneous activity** (e.g., fibrillations, positive sharp waves) at rest. - These findings reflect active muscle inflammation and necrosis, which are hallmarks of the disease.

Q: Which of the following is not a major criterion for rheumatic fever?

Arthralgia. **Arthralgia** - **Arthralgia** is a **minor criterion** for the diagnosis of **rheumatic fever**, indicating joint pain without objective signs of inflammation. - Major criteria require more definitive signs of inflammation, such as actual **arthritis** (pain with swelling, warmth, redness, or tenderness). *Subcutaneous nodule* - **Subcutaneous nodules** are **major criteria** for **rheumatic fever**, typically appearing over bony prominences. - These nodules are painless and firm, usually associated with severe carditis. *Carditis* - **Carditis** is a **major criterion** for **rheumatic fever**, representing inflammation of the heart [1]. - It can manifest as valvulitis, myocarditis, or pericarditis, and is the most serious manifestation of the disease [1]. *Erythema marginatum* - **Erythema marginatum** is a **major criterion** for **rheumatic fever**, characterized by a fleeting, non-pruritic rash with red margins and a clear center. - It is typically seen on the trunk and proximal extremities, sparing the face.

Q: In shigella dysentery associated hemolytic uremic syndrome, the false statement is ?

Hepatic failure. Detailed assessment of the complications of Hemolytic Uremic Syndrome (HUS) following Shigella infection shows that hepatic failure is not a characteristic component. ***Hepatic failure*** - **Hepatic failure** is not a typical hallmark or direct complication of **Shiga toxin-producing E. coli (STEC) HUS**, which primarily targets the kidneys. - The primary organs affected in **HUS** are the **kidneys (acute kidney injury)**, brain (neurological symptoms), and hematopoietic system (thrombocytopenia, microangiopathic hemolytic anemia) [2]. *Leucocytosis* - **Leucocytosis** (elevated white blood cell count) is a common finding in **Shigella dysentery**, reflecting the systemic inflammatory response to the infection. - It can be a predictive marker for the severity of **HUS** development in patients with **STEC** infection. *Thrombotic angiopathy* - **Thrombotic angiopathy** is the underlying pathological process in **HUS**, characterized by **microvascular thrombosis** and **endothelial damage** [1]. - These microthrombi lead to **thrombocytopenia**, **microangiopathic hemolytic anemia**, and **ischemic organ damage**, particularly in the kidneys [1], [2]. *Neurological abnormalities* - **Neurological abnormalities** such as seizures, altered mental status, and strokes can occur in a significant proportion of **HUS** patients. - These complications are due to **cerebral microthrombosis** and **endothelial damage** in the brain, affecting blood flow and neuronal function.

Q: Which of the following is a minor criteria for diagnosis of Rheumatic Fever (RF) according to modified Jones criteria?

Fever. ***Fever*** - **Fever** is considered a **minor criterion** in the modified Jones criteria for diagnosing Rheumatic Fever. - A temperature of **≥38°C** [1] is typically required to meet this criterion. *Subcutaneous nodules* - **Subcutaneous nodules** are a **major criterion** of the modified Jones criteria for Rheumatic Fever. - These firm, painless nodules are usually found over bony prominences. *Arthritis* - **Arthritis** (polyarthritis) is a **major criterion** for the diagnosis of Rheumatic Fever. - It characteristically presents as a **migratory polyarthritis**, affecting large joints. *Past History of Rheumatic Fever* - A **past history of Rheumatic Fever** is not a *diagnostic criterion* itself, but rather an important part of the patient's medical history that influences clinical suspicion [2]. - It would increase the likelihood of a recurrence, but does not serve as a minor or major diagnostic criterion in the modified Jones criteria [2].

Q: A35 yr old lady with Normal PT and increased aPTT. 2 year back, she was operated for cholecystectomy & did not have any bleeding episode. What is next investigation for clinical diagnosis -

Factor VIII assay. ***Factor VIII assay*** - An isolated **increased aPTT** with a **normal PT** points to an abnormality in the **intrinsic pathway** of coagulation, which includes Factor VIII [1]. - The absence of bleeding episodes for a cholecystectomy suggests a **mild deficiency** or a defect that doesn't cause severe hemorrhage, making Factor VIII deficiency (Hemophilia A) a strong consideration [2]. *Platelet aggregation test* - This test evaluates **platelet function**, abnormalities of which typically present with mucocutaneous bleeding and a normal PT and aPTT. - The patient's presentation of an isolated prolonged aPTT does not primarily suggest a platelet function disorder. *Anti viper venom assay* - This test is primarily used to detect the presence of **lupus anticoagulant**, which can cause a prolonged aPTT but is often associated with thrombotic events, not bleeding. - While lupus anticoagulant can prolong aPTT without bleeding, a Factor VIII deficiency is a more common cause of an isolated prolonged aPTT that is compatible with no significant bleeding history. *Ristocetin cofactor assay* - This assay is used to evaluate **von Willebrand factor (vWF)** activity, which is involved in platelet adhesion and also stabilizes Factor VIII [3]. - While vWF deficiency can cause a prolonged aPTT, it typically presents with mucocutaneous bleeding, and the patient's history doesn't strongly suggest this [3].

Q: Lambert-Eaton Myasthenic Syndrome is associated with?

Small cell lung carcinoma. ***Small cell lung carcinoma*** - **Lambert-Eaton Myasthenic Syndrome (LEMS)** is a paraneoplastic syndrome, most commonly associated with **small cell lung carcinoma (SCLC)** [1], [2]. - SCLC cells express **voltage-gated calcium channels** that are targeted by autoantibodies in LEMS, leading to impaired acetylcholine release [1]. *Vitiligo* - **Vitiligo** is an autoimmune skin condition causing depigmentation and is generally associated with other autoimmune diseases, not LEMS. - While both LEMS and vitiligo can involve immune dysregulation, there is no direct and common association between the two. *Hyperthyroidism* - **Hyperthyroidism**, particularly due to Graves' disease, is an autoimmune condition primarily affecting the thyroid gland. - It is not a known direct or common association with LEMS. Myasthenia gravis, however, can be associated with hyperthyroidism. *All of the options* - While LEMS is an autoimmune disorder, its primary and most significant association is with **small cell lung carcinoma** [1], [3]. - The other conditions listed (vitiligo, hyperthyroidism) are not directly or commonly linked to LEMS.

Q: Skin stigmata of Liver disease include all of the following, Except

Subcutaneous nodules. ***Subcutaneous nodules*** - **Subcutaneous nodules** are characteristic of conditions like **rheumatoid arthritis**, **rheumatic fever**, or **sarcoidosis**, but are not typically associated with liver disease. - While some systemic diseases with liver involvement can present with nodules (e.g., metastatic cancer), they are not a direct skin stigmata *of* liver disease itself. *Paper money skin* - **Paper money skin**, or **spider angiomata**, are common in chronic liver disease due to increased circulating **estrogens** which cause arteriole dilation. - They appear as small, red, spider-like lesions, particularly on the upper trunk and face. *Drumstick fingers* - **Drumstick fingers**, also known as **clubbing**, can be a manifestation of **chronic liver disease**, especially in conditions like **primary biliary cholangitis** [1]. - It involves bulbous enlargement of the distal phalanges with increased convexity of the nail fold [1]. *Palmar Erythema* - **Palmar erythema** is a reddening of the palms, particularly the thenar and hypothenar eminences, due to increased **estrogen levels** in liver disease. - It is a common sign of **chronic liver disease**, reflecting altered hormone metabolism.

Q: Manifestations of epidemic Dropsy are all except -

Cutaneous hemangiomas. The manifestations of epidemic dropsy are caused by the contamination of edible oils with sanguinarine, leading to systemic toxicity. While cutaneous hemangiomas are benign vascular tumors not associated with this condition, other systemic effects are prominent. Gastrointestinal bleeding can occur due to congestion and capillary damage in the GI tract, as hemorrhagic manifestations are common due to capillary fragility and increased vascular permeability [1]. Breathlessness is a frequent symptom [1] due to cardiac involvement (e.g., congestive heart failure) and pulmonary edema [1] resulting from widespread capillary leakage. Congestive heart failure (CHF) is a severe cardiac manifestation, primarily due to myocardial damage and increased vascular permeability leading to fluid overload. The direct cardiotoxic effects of sanguinarine on the myocardium contribute to pump failure [1].

Q: All of the following are true about nephrotic syndrome except?

Decreased serum triglycerides. ***Decreased serum triglycerides*** - Nephrotic syndrome is characterized by **hyperlipidemia**, including **elevated total cholesterol** and **triglycerides**, due to increased hepatic synthesis of lipoproteins and decreased catabolism [1]. - This is a direct consequence of the body's attempt to compensate for low oncotic pressure and is a major diagnostic feature. *Hypoalbuminemia* - This is a **hallmark characteristic** of nephrotic syndrome, resulting from the significant loss of albumin in the urine [1]. - A low serum albumin level (typically 3.5 g/day* - This is the **defining diagnostic criterion** for nephrotic syndrome, indicating massive protein excretion through damaged glomerular capillaries [1]. - The protein loss is specifically defined as >3.5 grams per 1.73 m² of body surface area per day. *Increased risk of infection* - Patients with nephrotic syndrome are prone to infections, particularly **bacterial infections** like spontaneous bacterial peritonitis [1]. - This increased risk is due to the urinary loss of **immunoglobulins** (especially IgG), complement factors, and impaired cellular immunity [1].

Q: All of the following are causes of ascites, EXCEPT:

Acute pancreatitis. ***Acute pancreatitis*** - While acute pancreatitis can cause fluid collections and sometimes **pancreatic ascites** [1] (due to pancreatic duct disruption), it is not a primary or common cause of generalized ascites. - The ascites seen in severe pancreatitis is typically **exudative** [1] and localized to the upper abdomen, distinct from the generalized **transudative** ascites often seen in other conditions. *Liver cirrhosis* - **Portal hypertension** due to cirrhosis leads to increased hydrostatic pressure in the splanchnic circulation, causing fluid to leak into the peritoneal cavity [1]. - Reduced **albumin synthesis** by the diseased liver also decreases plasma oncotic pressure, further contributing to fluid extravasation. *Peritoneal tuberculosis* - This condition causes inflammation of the peritoneum leading to increased **capillary permeability** and fluid exudation into the peritoneal cavity. - The ascites in peritoneal tuberculosis is typically **exudative** [1] and often accompanied by **abdominal pain**, fever, and weight loss. *Heart failure* - **Right-sided heart failure** leads to increased systemic venous pressure, which can cause congestion in the liver and elevated hepatic sinusoidal pressure. - This increased pressure forces fluid out of the hepatic sinusoids and into the peritoneal cavity, resulting in **cardiac ascites** [1].

Question 1

Which of the following is not true about polymyositis

Accepted Answer

Ophthalmoplegia

Answer

Limb girdle weakness

Answer

Para-neoplastic syndrome

Answer

Spontaneous discharge in EMG

Question 2

Which of the following is not a major criterion for rheumatic fever?

Accepted Answer

Arthralgia

Answer

Subcutaneous nodule

Answer

Carditis

Answer

Erythema marginatum

Question 3

In shigella dysentery associated hemolytic uremic syndrome, the false statement is ?

Accepted Answer

Hepatic failure

Answer

Leucocytosis

Answer

Thrombotic angiopathy

Answer

Neurological abnormalities

Question 4

Which of the following is a minor criteria for diagnosis of Rheumatic Fever (RF) according to modified Jones criteria?

Accepted Answer

Fever

Answer

Subcutaneous nodules

Answer

Arthritis

Answer

Past History of Rheumatic Fever

Question 5

A35 yr old lady with Normal PT and increased aPTT. 2 year back, she was operated for cholecystectomy & did not have any bleeding episode. What is next investigation for clinical diagnosis -

Accepted Answer

Factor VIII assay

Answer

Platelet aggregation test

Answer

Anti viper venom assay

Answer

Ristocetin cofactor assay

Question 6

Lambert-Eaton Myasthenic Syndrome is associated with?

Accepted Answer

Small cell lung carcinoma

Answer

Vitiligo

Answer

Hyperthyroidism

Answer

All of the options

Question 7

Skin stigmata of Liver disease include all of the following, Except

Accepted Answer

Subcutaneous nodules

Answer

Paper money skin

Answer

Drumstick fingers

Answer

Palmar Erythema

Question 8

Manifestations of epidemic Dropsy are all except -

Accepted Answer

Cutaneous hemangiomas

Answer

Gastrointestinal bleed

Answer

Breathlessness

Answer

CHF

Question 9

All of the following are true about nephrotic syndrome except?

Accepted Answer

Decreased serum triglycerides

Answer

Hypoalbuminemia

Answer

Proteinuria >3.5 g/day

Answer

Increased risk of infection

Question 10

All of the following are causes of ascites, EXCEPT:

Accepted Answer

Acute pancreatitis

Answer

Liver cirrhosis

Answer

Peritoneal tuberculosis

Answer

Heart failure

Clinical Manifestations and Presentation of Diseases — MCQs

Clinical Manifestations and Presentation of Diseases — MCQs

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