Clinical Manifestations and Presentation of Diseases Practice Questions

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 of the following are the symptoms commonly experienced by patients with lymphoedema? I. Swelling II. Burning sensation III. Intolerance to cold IV. Cramps Select the correct answer using the code given below :

I, II and IV. ***I, II and IV*** - **Swelling**, **burning sensation**, and **cramps** are common symptoms reported by patients with lymphedema, reflecting the impaired lymphatic drainage and associated tissue changes. - **Swelling** is the hallmark symptom, often accompanied by discomfort, pain, and sensory disturbances like burning or numbness, and muscle cramps are also frequently reported. *I, II and III* - While **swelling** and a **burning sensation** are typical, **intolerance to cold** is not a characteristic symptom of lymphedema. - **Intolerance to cold** is more commonly associated with conditions like **Raynaud's phenomenon** or **hypothyroidism**, not directly with lymphatic dysfunction. *I, III and IV* - Although **swelling** and **cramps** are common, **intolerance to cold** is not a primary symptom of lymphedema. - The cardinal signs of lymphedema relate to fluid accumulation and tissue changes, not systemic temperature dysregulation. *II, III and IV* - While a **burning sensation** and **cramps** can occur, the most prominent and always present symptom of lymphedema, **swelling**, is missing from this option. - **Intolerance to cold** is not characteristic of lymphedema, making this option less accurate.

Q: A 42 year old man presented with recurrent oral ulcers since one year, episodes of redness of eye and genital ulcers. Which one of the following tests is of diagnostic value?

Pathergy test. ***Pathergy test*** - The constellation of **recurrent oral and genital ulcers** along with **ocular inflammation (redness of eye)** is highly suggestive of **Behçet's disease**. - The **pathergy test** assesses for a hyper-reactivity of the skin to needle prick, which is characteristic of Behçet's disease and thus of diagnostic value. *Drug-sensitivity test* - This test is primarily used to identify allergic reactions or sensitivities to specific medications. - It would not be indicated for diagnosing a systemic inflammatory condition like Behçet's disease. *Patch test* - A **patch test** is used to identify substances that cause allergic contact dermatitis by applying potential allergens to the skin. - It is not relevant for the diagnosis of Behçet's disease, which involves inflammatory rather than allergic reactions. *Mantoux test* - The **Mantoux test** (tuberculin skin test) is used to screen for **tuberculosis infection** [1]. - This patient's symptoms are not consistent with tuberculosis, and the Mantoux test has no role in diagnosing Behçet's disease [2].

Q: Which of the following statements are typical for classic heat stroke? I. Older patient II. Normokalemia III. Hyponatremia IV. Marked lactic acidosis Select the correct answer using the code given below :

I and III. ***I and III*** - **Older patients** are particularly susceptible to classic heat stroke due to impaired thermoregulation and reduced ability to acclimate to heat [1], [2]. - **Hyponatremia** can occur in classic heat stroke due to excessive fluid intake (often plain water) that dilutes serum sodium, or increased sodium loss through sweat. *II and IV* - **Normokalemia** is not typical in severe heat stroke, as **hyperkalemia** is more common due to **rhabdomyolysis** and **cellular damage**. - While metabolic acidosis is common, **marked lactic acidosis** is more characteristic of **exertional heat stroke** due to intense muscle activity, rather than classic heat stroke [1]. *I and II* - While **older patients** are a key risk factor for classic heat stroke [2], **normokalemia** is less typical, with **hyperkalemia** being a more frequent finding in severe cases. - **Normokalemia** would not adequately explain the electrolyte disturbances seen in severe heat stroke. *III and IV* - **Hyponatremia** is a common finding in classic heat stroke due to dilutional effects or sodium loss. - However, **marked lactic acidosis** is predominantly seen in **exertional heat stroke** rather than classic heat stroke, which is more associated with environmental heat exposure [1].

Q: A 32 year old man presents with history of recurrent jaundice over the previous decade. Family gives history of the patient having episodes of facial grimacing. Which one of the following is a clinical clue to the diagnosis?

Kayser-Fleisher rings in the cornea. Detailed clinical features point towards Wilson's disease. ***Kayser-Fleisher rings in the cornea*** - The history of **recurrent jaundice** and **facial grimacing** (likely dystonia/tremors) points towards a **neuropsychiatric disorder** with liver involvement, which is characteristic of **Wilson's disease** [1]. - **Kayser-Fleisher rings** are copper deposits in the Descemet's membrane of the cornea, a pathognomonic sign of Wilson's disease. *Adenoma sebaceum in the mid face* - **Adenoma sebaceum** (facial angiofibromas) is a characteristic skin lesion associated with **tuberous sclerosis complex**, which typically presents with seizures, intellectual disability, and characteristic skin lesions, not recurrent jaundice or facial grimacing indicative of movement disorders. - This condition does not primarily involve recurrent jaundice or movement disorders like facial grimacing. *Erythema nodosum on the skin* - **Erythema nodosum** is an inflammatory condition characterized by painful, red nodules, typically on the shins. - It is often associated with conditions like **sarcoidosis**, inflammatory bowel disease, infections, or drug reactions, and does not commonly present with recurrent jaundice and facial grimacing. *Osler's nodes at the finger tips* - **Osler's nodes** are painful, tender, red or purple lesions found on the fingertips and toes, indicative of **infective endocarditis**. - This symptom is related to immune complex deposition and systemic infection, rather than genetic disorders causing liver disease and neurological dysfunction.

Q: Which one of the following terms denotes the extensive sclerosis of the skin of the chest wall which restricts chest wall movement and is seen as a rare complication of systemic sclerosis?

Hidebound Chest. ***Hidebound Chest*** - This term precisely describes the **extensive cutaneous sclerosis** over the chest wall seen in **systemic sclerosis**, leading to restricted chest movement [1]. - The hardened, thickened skin reduces chest wall compliance, making breathing difficult [1]. *Barrel Chest* - Characterized by an **increased anterior-posterior diameter** of the chest, commonly seen in chronic obstructive pulmonary disease (COPD) due to hyperinflation. - It is not primarily caused by skin sclerosis but rather by lung pathology. *Flail Chest* - Occurs when a segment of the rib cage breaks due to trauma and becomes detached from the rest of the chest wall. - This results in **paradoxical movement** of the chest wall during respiration, and is an acute traumatic injury. *Pigeon Chest* - Also known as **Pectus Carinatum**, this chest wall deformity is characterized by a **protrusion of the sternum and costal cartilages**. - It is typically a developmental anomaly rather than a consequence of skin sclerosis.

Q: Which one of the following conditions is a complication of bacterial pharyngitis involving extension of infection into the internal jugular veins leading to thrombosis and metastatic dispersal of the organism?

Lemierre syndrome. ***Lemierre syndrome*** - This syndrome is characterized by **bacterial pharyngitis** that extends to the **internal jugular vein**, leading to **thrombosis** and subsequent septic emboli [3]. - The most common causative organism is ***Fusobacterium necrophorum***, and it can result in metastatic infections in organs like the lungs. *Wegener's granulomatosis* - This is an **autoimmune vasculitis** affecting small to medium-sized vessels, primarily in the respiratory tract and kidneys [2]. - It is distinct from infection-related venous thrombosis and is characterized by **granulomatous inflammation** and **ANCA positivity**. *Chronic Pulmonary Aspergillosis* - This is a fungal infection of the lungs, typically occurring in individuals with pre-existing lung conditions or immunosuppression [1]. - It does not involve the initial presentation of bacterial pharyngitis followed by internal jugular vein thrombosis. *Cystic Fibrosis* - This is an **autosomal recessive genetic disorder** affecting exocrine glands, leading to thick, sticky mucus, primarily impacting the lungs and digestive system. - While it causes chronic respiratory infections, it is not initiated by bacterial pharyngitis leading to septic thrombophlebitis of the jugular vein.

Question 1

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 2

Which of the following are the symptoms commonly experienced by patients with lymphoedema?
I. Swelling
II. Burning sensation
III. Intolerance to cold
IV. Cramps

Select the correct answer using the code given below :

Accepted Answer

I, II and IV

Answer

I, II and III

Answer

II, III and IV

Answer

I, III and IV

Question 3

Which of the following statements are correct regarding hypernatremia in children?
I. Diabetes insipidus due to a deficiency of antidiuretic hormone (ADH) may cause hypernatremia
II. Addison disease may be associated with hypernatremia
III. Use of boiled skimmed milk can lead to hypernatremia
IV. Use of lactulose can lead to hypernatremia

Select the answer using the code given below :

Accepted Answer

I, III and IV

Answer

II, III and IV

Answer

I, II and IV

Answer

I, II and III

Question 4

A 42 year old man presented with recurrent oral ulcers since one year, episodes of redness of eye and genital ulcers. Which one of the following tests is of diagnostic value?

Accepted Answer

Pathergy test

Answer

Drug-sensitivity test

Answer

Patch test

Answer

Mantoux test

Question 5

Which of the following statements are typical for classic heat stroke?
I. Older patient
II. Normokalemia
III. Hyponatremia
IV. Marked lactic acidosis

Select the correct answer using the code given below :

Accepted Answer

I and III

Answer

II and IV

Answer

I and II

Answer

III and IV

Question 6

A 32 year old man presents with history of recurrent jaundice over the previous decade. Family gives history of the patient having episodes of facial grimacing. Which one of the following is a clinical clue to the diagnosis?

Accepted Answer

Kayser-Fleisher rings in the cornea

Answer

Adenoma sebaceum in the mid face

Answer

Erythema nodosum on the skin

Answer

Osler's nodes at the finger tips

Question 7

Which one of the following terms denotes the extensive sclerosis of the skin of the chest wall which restricts chest wall movement and is seen as a rare complication of systemic sclerosis?

Accepted Answer

Hidebound Chest

Answer

Barrel Chest

Answer

Flail Chest

Answer

Pigeon Chest

Question 8

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 9

Which one of the following conditions is a complication of bacterial pharyngitis involving extension of infection into the internal jugular veins leading to thrombosis and metastatic dispersal of the organism?

Accepted Answer

Lemierre syndrome

Answer

Wegener's granulomatosis

Answer

Chronic Pulmonary Aspergillosis

Answer

Cystic Fibrosis

Question 10

Which one of the following statements is correct in respect of pulmonary involvement in rheumatoid disease?

Accepted Answer

Rheumatoid pulmonary nodules are usually asymptomatic and detected incidentally on imaging

Answer

Pleural effusion in these patients is transudative and usually bilateral

Answer

Rheumatoid pulmonary nodules are often solitary and located near hilum

Answer

Combination of pleural effusion and pneumoconiosis in these patients is known as Caplan syndrome

Clinical Manifestations and Presentation of Diseases — MCQs

Clinical Manifestations and Presentation of Diseases — MCQs

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