Clinical Manifestations and Presentation of Diseases — MCQs
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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 :
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 :
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 :
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?
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 :
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?
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?
Which one of the following statements is correct for subcutaneous nodules in Rheumatic fever?
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?
Which one of the following statements is correct in respect of pulmonary involvement in rheumatoid disease?
Clinical Manifestations and Presentation of Diseases Indian Medical PG Practice Questions and MCQs
Question 81: 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 :
- A. I, II and IV
- B. II, III and IV
- C. I, II and III (Correct Answer)
- D. I, III and IV
Explanation: ***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.
Question 82: 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 :
- A. I, II and III
- B. II, III and IV
- C. I, III and IV
- D. I, II and IV (Correct Answer)
Explanation: ***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.
Question 83: 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 :
- A. II, III and IV
- B. I, III and IV (Correct Answer)
- C. I, II and IV
- D. I, II and III
Explanation: ***I, III and IV*** - **Diabetes insipidus**, whether central (deficient ADH) or nephrogenic (renal unresponsiveness to ADH), leads to excessive free water loss, causing **hypernatremia** if fluid intake does not compensate [1]. - **Boiled skimmed milk** for infants can have a high solute load (especially sodium and protein) and inadequate free water, overwhelming immature renal capacity and leading to **dehydration** and **hypernatremia**. - **Lactulose** is an osmotic laxative that draws water into the colon, which can lead to **dehydration** and potentially **hypernatremia** if significant fluid losses occur, especially in vulnerable populations like infants or the elderly. *II, III and IV* - **Addison's disease** (adrenocortical insufficiency) typically causes **hyponatremia** due to mineralocorticoid deficiency leading to renal sodium wasting and potassium retention, not hypernatremia [2]. - **Boiled skimmed milk** for infants can have a high solute load and inadequate free water, overwhelming immature renal capacity and leading to dehydration and hypernatremia. - **Lactulose** is an osmotic laxative that draws water into the colon, which can lead to dehydration and potentially hypernatremia if significant fluid losses occur. *I, II and IV* - **Diabetes insipidus**, due to a deficiency of ADH, causes uncompensated free water loss and thus **hypernatremia**. - **Addison's disease** usually causes **hyponatremia** due to impaired sodium reabsorption in the renal tubules, not hypernatremia [2]. - **Lactulose** can cause significant osmotic diarrhea, leading to free water loss and subsequent **hypernatremia** if not adequately replaced. *I, II and III* - **Diabetes insipidus** involves a lack of ADH, leading to unchecked water excretion and subsequent **hypernatremia** [1]. - **Addison's disease** leads to adrenal insufficiency, causing **hyponatremia** and hyperkalemia due to aldosterone deficiency [2]. - Feeding infants **boiled skimmed milk**, which is high in solute content and low in free water, can lead to increased renal solute load and excessive water loss, resulting in **hypernatremia**.
Question 84: 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?
- A. Drug-sensitivity test
- B. Pathergy test (Correct Answer)
- C. Patch test
- D. Mantoux test
Explanation: ***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].
Question 85: 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 :
- A. I and III (Correct Answer)
- B. II and IV
- C. I and II
- D. III and IV
Explanation: ***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].
Question 86: 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?
- A. Kayser-Fleisher rings in the cornea (Correct Answer)
- B. Adenoma sebaceum in the mid face
- C. Erythema nodosum on the skin
- D. Osler's nodes at the finger tips
Explanation: 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.
Question 87: 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?
- A. Barrel Chest
- B. Flail Chest
- C. Hidebound Chest (Correct Answer)
- D. Pigeon Chest
Explanation: ***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.
Question 88: Which one of the following statements is correct for subcutaneous nodules in Rheumatic fever?
- A. They are present over flexor aspect of forearm
- B. They are painful tender nodules
- C. They typically appear more than 3 weeks after onset of other clinical manifestations (Correct Answer)
- D. The usual size of these nodules is 3-5 cm
Explanation: ***They typically appear more than 3 weeks after onset of other clinical manifestations*** - Subcutaneous nodules in **rheumatic fever** are a late manifestation, typically appearing several weeks into the disease course. - Their presence often indicates **severe carditis**, particularly in recurrent attacks [1]. *They are present over flexor aspect of forearm* - These nodules are characteristically found over **bony prominences** and/or attached to **tendons**, such as over the knuckles, elbows, knees, ankles, and along the spine, not specifically the flexor aspect of the forearm. - Their location is often related to areas subject to pressure or friction. *They are painful tender nodules* - Subcutaneous nodules in rheumatic fever are typically described as **firm, discrete, and painless**. - Their lack of tenderness helps differentiate them from other nodular lesions. *The usual size of these nodules is 3-5 cm* - The nodules are usually **small**, ranging from a few millimeters to about 2 cm in diameter. - They are often **non-erythematous** and not easily visible unless specifically looked for or palpated.
Question 89: 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?
- A. Wegener's granulomatosis
- B. Lemierre syndrome (Correct Answer)
- C. Chronic Pulmonary Aspergillosis
- D. Cystic Fibrosis
Explanation: ***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 90: Which one of the following statements is correct in respect of pulmonary involvement in rheumatoid disease?
- A. Pleural effusion in these patients is transudative and usually bilateral
- B. Rheumatoid pulmonary nodules are often solitary and located near hilum
- C. Rheumatoid pulmonary nodules are usually asymptomatic and detected incidentally on imaging (Correct Answer)
- D. Combination of pleural effusion and pneumoconiosis in these patients is known as Caplan syndrome
Explanation: ***Rheumatoid pulmonary nodules are usually asymptomatic and detected incidentally on imaging*** - **Rheumatoid pulmonary nodules** are discrete, often well-circumscribed lesions that typically occur in patients with **rheumatoid arthritis (RA)** [2]. - They are frequently **asymptomatic** and discovered during routine chest imaging. *Pleural effusion in these patients is transudative and usually bilateral* - **Rheumatoid pleural effusions** are typically **exudative**, not transudative, reflecting an inflammatory process [1]. - While they can be bilateral, they are more commonly **unilateral**, often on the right side. *Rheumatoid pulmonary nodules are often solitary and located near hilum* - While rheumatoid nodules can be solitary, they are more often **multiple** and tend to be located in the **periphery** of the lung, not typically near the hilum. - Their size can vary, and they may sometimes cavitate. *Combination of pleural effusion and pneumoconiosis in these patients is known as Caplan syndrome* - **Caplan syndrome** is characterized by the presence of **multiple, firm, peripheral lung nodules (rheumatoid nodules)** in individuals with **rheumatoid arthritis** and concurrent **pneumoconiosis** (e.g., coal worker's pneumoconiosis, silicosis) [3]. - It does not specifically refer to a combination of pleural effusion and pneumoconiosis, though pleural effusions can occur in RA.
Practice by Chapter
Approach to Common Symptoms (Fever, Pain, Fatigue)
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Constitutional Symptoms and Their Differential Diagnosis
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Syncope and Presyncope
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Dizziness and Vertigo
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Dyspnea and Respiratory Distress
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Chest Pain Evaluation
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Abdominal Pain Assessment
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Headache Classification and Management
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Weight Loss and Cachexia
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Edema and Fluid Retention
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