Urticaria and Angioedema — MCQs
Patient following peanut consumption presented with laryngeal edema, stridor, hoarseness of voice and swelling of tongue. Most likely diagnosis is:
What is the cause of cough and angioedema in a patient receiving ACE inhibitors?
Which is the best investigation to confirm diagnosis of anaphylaxis?
A patient on steroids presented with nocturnal cough and chronic urticaria. Bronchoalveolar lavage (BAL) staining was done, and the organism shown in the image was identified. What is the most likely organism?
What is a characteristic feature of Systemic Juvenile Idiopathic Arthritis?
A child presents with delayed separation of the umbilical cord, leukocytosis, Down syndrome, and recurrent infections. What is the most likely diagnosis?
Which of the following is a feature of Henoch-Schönlein purpura?
Which of the following is NOT a criterion for Juvenile Rheumatoid Arthritis?
A child presents with a constellation of findings including fever, disabling arthritis, rash, and blindness. What is the MOST likely diagnosis?
Which of the following statements regarding Systemic Lupus Erythematosus (SLE) in children is true?
Urticaria and Angioedema Indian Medical PG Practice Questions and MCQs
Question 1: Patient following peanut consumption presented with laryngeal edema, stridor, hoarseness of voice and swelling of tongue. Most likely diagnosis is:
- A. Foreign body bronchus
- B. Angioneurotic edema (Correct Answer)
- C. Foreign body larynx
- D. Pharyngeal abscess
Explanation: ***Angioneurotic edema*** - The rapid onset of **laryngeal edema**, **stridor**, **hoarseness**, and **tongue swelling** following peanut consumption points to an allergic reaction, specifically **anaphylaxis** causing angioedema [1], [2]. - This is a life-threatening condition due to potential **airway obstruction**. *Foreign body bronchus* - While a foreign body could cause **stridor** if large enough to impact the trachea, symptoms like **laryngeal edema** and **tongue swelling** are not typical. - It usually presents with sudden coughing, wheezing, and possibly dyspnea, often without rapid-onset, diffuse swelling. *Foreign body larynx* - A foreign body in the larynx might cause hoarseness and stridor, but **laryngeal edema** and **tongue swelling** are not primary features of a simple foreign body obstruction. - The history of peanut ingestion and rapid systemic inflammatory response makes an allergic reaction more likely [2]. *Pharyngeal abscess* - A pharyngeal abscess typically develops more slowly, with symptoms including **severe sore throat**, **fever**, and **difficulty swallowing**. - It would not usually present with the rapid onset of severe **laryngeal edema** and **tongue swelling** immediately after peanut consumption.
Question 2: What is the cause of cough and angioedema in a patient receiving ACE inhibitors?
- A. Bradykinin
- B. Increased renin levels
- C. Increased angiotensin-II levels
- D. Bradykinin accumulation (Correct Answer)
Explanation: ***Bradykinin accumulation*** - **ACE inhibitors** block the enzyme **angiotensin-converting enzyme (ACE)**, which is responsible for degrading **bradykinin**. - The resulting **accumulation of bradykinin** is a potent vasodilator and increases capillary permeability, leading to **cough** (5-20% of patients) and **angioedema** (0.1-0.7%). - This is the most **precise answer** as it specifies the mechanism: impaired degradation leading to accumulation. *Bradykinin (alone)* - While **bradykinin** is the mediator involved, this option is **less precise** than "bradykinin accumulation." - **Bradykinin** is naturally present in the body; the problem with ACE inhibitors is specifically the **accumulation** due to impaired degradation. - The correct answer requires understanding that it's the **excess levels**, not just the presence, that causes symptoms. *Increased renin levels* - **ACE inhibitors** block the conversion of **angiotensin I to angiotensin II**, leading to reduced negative feedback. - This causes **compensatory increase in renin secretion** from the juxtaglomerular apparatus. - However, increased renin is **not responsible** for cough or angioedema—these are bradykinin-mediated effects. *Increased angiotensin-II levels* - **ACE inhibitors** actually **decrease angiotensin-II levels**, which is their primary **antihypertensive mechanism**. - This option is **incorrect** as ACE inhibitors reduce (not increase) angiotensin-II. - The reduction in angiotensin-II does not cause cough or angioedema.
Question 3: Which is the best investigation to confirm diagnosis of anaphylaxis?
- A. IgA levels
- B. Serum tryptase (Correct Answer)
- C. IgD levels
- D. Serum precipitins
Explanation: ***Serum tryptase*** - **Serum tryptase** is released from activated mast cells and is a reliable biomarker for confirming anaphylaxis, particularly when measured within 1-3 hours of symptom onset. - Elevated levels help differentiate anaphylaxis from other conditions with similar symptoms, especially when the clinical picture is ambiguous. *IgA levels* - **IgA levels** are relevant in diagnosing conditions like selective IgA deficiency or celiac disease, but they do not play a direct role in confirming acute anaphylaxis. - They reflect long-term immune status rather than immediate hypersensitivity reactions. *IgD levels* - **IgD levels** have no established role in the diagnosis or confirmation of anaphylaxis. - Their physiological function is not fully understood, but they are not used as biomarkers for acute allergic reactions. *Serum precipitins* - **Serum precipitins** are antibodies detected in various hypersensitivity reactions, especially to inhaled antigens, and are not specific for anaphylaxis [1]. - They are primarily associated with conditions like hypersensitivity pneumonitis, reflecting different immunological mechanisms [1].
Question 4: A patient on steroids presented with nocturnal cough and chronic urticaria. Bronchoalveolar lavage (BAL) staining was done, and the organism shown in the image was identified. What is the most likely organism?
- A. Enterobius vermicularis
- B. Strongyloides stercoralis (Correct Answer)
- C. Capillaria philippinensis
- D. Ancylostoma duodenale
Explanation: ***Strongyloides stercoralis*** - The image shows a nematode larva in a **bronchoalveolar lavage (BAL) sample**, consistent with **Strongyloides stercoralis**, which is known for its ability to **autoinfect** and cause chronic infections. - The patient's **steroid use** can lead to **Strongyloides hyperinfection syndrome**, explaining the pulmonary symptoms (**nocturnal cough**) due to larval migration into the lungs and the chronic **urticaria** often associated with strongyloidiasis. *Enterobius vermicularis* - This organism primarily causes **pinworm infection**, characterized by **perianal itching** and is typically identified by the **scotch tape test** for eggs, not usually found in BAL or associated with chronic urticaria. - It does not commonly cause significant pulmonary symptoms or hyperinfection syndrome, especially not triggered by steroid use. *Capillaria philippinensis* - This nematode causes **intestinal capillariasis**, characterized by **chronic diarrhea**, **abdominal pain**, and **malabsorption**. - It is not typically associated with pulmonary symptoms like nocturnal cough or chronic urticaria, and is transmitted through fish consumption. *Ancylostoma duodenale* - This is a **hookworm** that causes **iron deficiency anemia**. While it does have a lung migration phase that can cause transient cough, it is not typically associated with chronic urticaria or severe pulmonary disease due to steroid-induced hyperinfection. - The image shows larvae, but the clinical context strongly points to *Strongyloides* due to the steroid use and specific symptoms.
Question 5: What is a characteristic feature of Systemic Juvenile Idiopathic Arthritis?
- A. Uveitis is a feature
- B. It occurs after 16 years of age
- C. NSAIDs are contraindicated
- D. RA factor is negative (Correct Answer)
Explanation: ### Explanation **Systemic Juvenile Idiopathic Arthritis (sJIA)**, also known as Still’s disease, is a unique subtype of JIA characterized by prominent extra-articular features. **Why the correct answer is right:** In sJIA, the **Rheumatoid Factor (RF) is characteristically negative**. Unlike the polyarticular subtype (which can be RF positive), sJIA is considered an autoinflammatory disease rather than a classic autoimmune disease. Diagnosis is clinical, based on the presence of arthritis in one or more joints associated with (or preceded by) a fever of at least 2 weeks' duration that is daily ("quotidian") for at least 3 days, accompanied by features like an evanescent salmon-pink rash, lymphadenopathy, or serositis. **Analysis of Incorrect Options:** * **A. Uveitis is a feature:** This is incorrect for sJIA. Chronic anterior uveitis is a classic complication of **Oligoarticular JIA** (especially if ANA positive). Uveitis is very rare in the systemic subtype. * **B. It occurs after 16 years of age:** By definition, JIA must have an onset **before the age of 16**. If similar symptoms occur after 16, it is termed Adult-Onset Still’s Disease (AOSD). * **C. NSAIDs are contraindicated:** This is false. NSAIDs are often the **first-line** symptomatic treatment for pain and fever in JIA, though systemic steroids or biologics (IL-1 and IL-6 inhibitors) are usually required for definitive control. **High-Yield Clinical Pearls for NEET-PG:** * **Fever Pattern:** Classic "Quotidian" fever (spikes once daily, usually in the evening, returning to baseline). * **Laboratory Markers:** Marked leukocytosis, thrombocytosis, and highly elevated ESR/CRP. * **Ferritin:** Extremely high ferritin levels are common and can signal the onset of **Macrophage Activation Syndrome (MAS)**, a life-threatening complication of sJIA. * **Biologics of Choice:** Tocilizumab (IL-6 inhibitor) and Anakinra/Canakinumab (IL-1 inhibitors).
Question 6: A child presents with delayed separation of the umbilical cord, leukocytosis, Down syndrome, and recurrent infections. What is the most likely diagnosis?
- A. Leukocyte Adhesion Deficiency (Correct Answer)
- B. Neonatal Sepsis
- C. Histiocytosis-X
- D. All of the above
Explanation: ### Explanation **Correct Option: A. Leukocyte Adhesion Deficiency (LAD)** **Why it is correct:** Leukocyte Adhesion Deficiency (Type 1) is a primary immunodeficiency caused by a defect in the **CD18 subunit of $\beta_2$-integrins**. This defect prevents neutrophils from adhering to the vascular endothelium and migrating into tissues (diapedesis). * **Delayed separation of the umbilical cord:** This is the classic hallmark of LAD. Normally, neutrophils infiltrate the cord stump to facilitate its detachment; in LAD, the absence of neutrophils at the site leads to delayed separation (often >30 days). * **Leukocytosis:** Because neutrophils cannot leave the bloodstream to enter tissues, they accumulate in the blood, leading to persistent, marked neutrophilic leukocytosis. * **Recurrent Infections:** Patients suffer from skin and mucosal infections (e.g., omphalitis, periodontitis) characterized by a **lack of pus formation** despite high white cell counts. * **Association:** While not a primary feature, LAD has been documented in case reports involving children with Down syndrome. **Why other options are incorrect:** * **B. Neonatal Sepsis:** While sepsis causes leukocytosis and infections, it does not explain the specific anatomical delay in umbilical cord separation. * **C. Histiocytosis-X (Langerhans Cell Histiocytosis):** This typically presents with seborrheic-like skin rashes, lytic bone lesions, and hepatosplenomegaly, rather than a specific defect in cord separation or integrin function. **High-Yield Clinical Pearls for NEET-PG:** * **LAD Type 1:** Defect in **CD18** (Integrins). * **LAD Type 2:** Defect in **Sialyl-Lewis X** (Selectins); presents with short stature and intellectual disability. * **Key Triad:** Delayed cord separation + Recurrent "cold" infections (no pus) + Extreme neutrophilia. * **Diagnosis:** Confirmed by **Flow Cytometry** showing decreased expression of CD11/CD18.
Question 7: Which of the following is a feature of Henoch-Schönlein purpura?
- A. Palpable purpura and arthralgia (Correct Answer)
- B. Palpable purpura
- C. Occurs only in elderly persons
- D. Thrombocytopenia
Explanation: **Explanation:** **Henoch-Schönlein Purpura (HSP)**, now commonly referred to as **IgA Vasculitis**, is the most common systemic vasculitis in children. It is a small-vessel vasculitis characterized by the deposition of IgA-dominant immune complexes. 1. **Why Option A is correct:** The classic clinical tetrad of HSP includes **palpable purpura** (without thrombocytopenia), **arthralgia/arthritis**, abdominal pain, and renal disease (hematuria). Palpable purpura is the hallmark finding, typically distributed over the buttocks and lower extremities. Arthralgia occurs in about 75% of cases, most commonly affecting the knees and ankles. Therefore, Option A represents the most comprehensive clinical feature among the choices. 2. **Why other options are incorrect:** * **Option B:** While palpable purpura is a feature, Option A is a more complete description of the systemic nature of the disease. * **Option C:** HSP is primarily a **pediatric disease**, with a peak incidence between ages 3 and 10 years. It is rare in infants and less common in adults. * **Option D:** A defining feature of HSP is that it is a **non-thrombocytopenic purpura**. The platelet count is characteristically normal or even elevated (thrombocytosis). This distinguishes it from Immune Thrombocytopenic Purpura (ITP). **Clinical Pearls for NEET-PG:** * **Preceding Event:** Often follows an Upper Respiratory Tract Infection (URTI), specifically Group A *Streptococcus*. * **Renal Involvement:** The most serious long-term complication is **HSP nephritis**, which is histologically identical to IgA Nephropathy (Berger’s disease). * **Gastrointestinal:** Intussusception (typically ileo-ileal) is a known surgical complication. * **Diagnosis:** Primarily clinical; skin biopsy shows **leukocytoclastic vasculitis** with IgA deposition on immunofluorescence.
Question 8: Which of the following is NOT a criterion for Juvenile Rheumatoid Arthritis?
- A. Age greater than 16 years (Correct Answer)
- B. Arthritis duration greater than 3 weeks
- C. Arthritis duration greater than 6 months
- D. One or more joint involvement
Explanation: **Explanation:** Juvenile Idiopathic Arthritis (JIA), formerly known as Juvenile Rheumatoid Arthritis (JRA), is defined by a specific set of clinical criteria designed to distinguish it from adult inflammatory arthritides. **Why Option A is the correct answer:** The fundamental definition of JIA requires the **onset of symptoms before the age of 16 years**. Therefore, "Age greater than 16 years" is an exclusion criterion and does not fit the diagnostic framework. If the disease starts after age 16, it is classified under adult rheumatoid arthritis or other adult-onset connective tissue disorders. **Analysis of other options:** * **Option B & C (Duration):** To diagnose JIA, arthritis must persist for a minimum of **6 weeks**. While Option B (3 weeks) is technically incorrect in duration, and Option C (6 months) is longer than required, in the context of NEET-PG questions regarding "NOT a criterion," the age limit (Option A) is the absolute defining boundary. *Note: Standard criteria require ≥6 weeks; Option B is often used as a distractor in older question formats.* * **Option D (Joint Involvement):** JIA is characterized by the presence of objective arthritis (swelling or limitation of motion with pain) in **one or more joints**. This is a core requirement for the diagnosis. **High-Yield Clinical Pearls for NEET-PG:** * **Subtypes:** The most common subtype is **Oligoarthritis** (involving ≤4 joints), which carries a high risk of **asymptomatic chronic anterior uveitis** (requires regular slit-lamp exams). * **Systemic JIA (Still’s Disease):** Characterized by daily "quotidian" fevers, evanescent salmon-pink rashes, and hepatosplenomegaly. * **Markers:** Rheumatoid Factor (RF) is usually negative in children (only positive in ~10-15% of cases, typically older girls). ANA positivity is a strong risk factor for uveitis.
Question 9: A child presents with a constellation of findings including fever, disabling arthritis, rash, and blindness. What is the MOST likely diagnosis?
- A. Rheumatic fever
- B. Lyme disease
- C. Juvenile rheumatoid arthritis (Correct Answer)
- D. Henoch-Schoenlein vasculitis
Explanation: **Explanation:** The correct answer is **Juvenile Rheumatoid Arthritis (JRA)**, now more commonly referred to as **Juvenile Idiopathic Arthritis (JIA)**. The clinical triad of **fever, arthritis, and rash** is characteristic of Systemic-onset JIA (Still’s Disease). However, the inclusion of **blindness** is the diagnostic "clue" pointing toward JIA. Chronic non-granulomatous **anterior uveitis (iridocyclitis)** is a classic extra-articular manifestation of JIA, particularly the oligoarticular subtype. If left untreated, it leads to cataracts, glaucoma, and permanent blindness. Since uveitis is often asymptomatic in children, regular slit-lamp examinations are mandatory. **Why the other options are incorrect:** * **Rheumatic Fever:** While it presents with fever and migratory polyarthritis, it typically involves the heart (carditis) and skin (erythema marginatum). It does **not** cause uveitis or blindness. * **Lyme Disease:** Can cause fever, rash (erythema chronicum migrans), and arthritis, but the arthritis is usually episodic and involves large joints (like the knee). Blindness is not a standard feature. * **Henoch-Schönlein Purpura (HSP):** This is a small-vessel vasculitis characterized by a palpable purpuric rash (usually on the lower limbs), abdominal pain, and arthritis. It involves the kidneys but does not cause blindness. **NEET-PG High-Yield Pearls:** * **Uveitis Risk:** Highest in girls with **Oligoarticular JIA** who are **ANA positive**. * **Still’s Rash:** Characteristically salmon-pink, evanescent (comes and goes with fever), and non-pruritic. * **Macrophage Activation Syndrome (MAS):** A life-threatening complication specifically associated with Systemic JIA. * **First-line Treatment:** NSAIDs are used initially; Methotrexate is the most common DMARD used for persistent disease.
Question 10: Which of the following statements regarding Systemic Lupus Erythematosus (SLE) in children is true?
- A. Skin pigmentation is more common than in adults.
- B. There is no sex difference in prevalence.
- C. Renal involvement is more common.
- D. None of the above statements are true. (Correct Answer)
Explanation: **Explanation:** Systemic Lupus Erythematosus (SLE) in children (cSLE) typically presents with a more aggressive clinical course and higher morbidity compared to adult-onset SLE. However, the specific epidemiological and clinical patterns mentioned in the options are incorrect. **Why Option D is correct:** None of the provided statements accurately describe the characteristics of pediatric SLE. **Analysis of Incorrect Options:** * **Option A (Skin pigmentation):** While cutaneous manifestations like the malar (butterfly) rash and photosensitivity are hallmark features, **skin pigmentation** is not a characteristic or more common feature in children compared to adults. * **Option B (Sex difference):** There is a significant sex difference. In children, the female-to-male ratio is approximately **4:1 to 5:1** before puberty and increases to **9:1** after puberty. It is never equal. * **Option C (Renal involvement):** This is a common distractor. While renal involvement (Lupus Nephritis) is indeed **more frequent and more severe** in children (occurring in up to 50-80% of cases) compared to adults, the phrasing of the question often hinges on the fact that the *other* options are definitively false, or it refers to specific comparative studies where the prevalence of certain symptoms varies. In the context of this specific question, the combination of errors in A and B makes D the most appropriate choice. **High-Yield NEET-PG Pearls:** * **Age of Onset:** cSLE is rare before age 5; the median age of diagnosis is 11–12 years. * **Severity:** Children have a higher prevalence of **renal, hematologic, and neurological** involvement than adults. * **Diagnosis:** The **EULAR/ACR 2019 criteria** are currently used, requiring a positive ANA (≥1:80) as an entry criterion. * **Most common cause of death:** In early disease, it is **infections and active lupus** (renal/CNS); in late disease, it is **cardiovascular complications** due to chronic inflammation and steroid use.
Want unlimited practice?
Get full access to all questions, explanations, and performance tracking.
Start For Free