Clinical Manifestations and Presentation of Diseases — MCQs

Clinical Manifestations and Presentation of Diseases Indian Medical PG Practice Questions and MCQs

Question 331: Which condition is characterized by atrophic dry nasal mucosa, extensive encrustations, and a woody hard external nose?

A. Diabetes mellitus (Correct Answer)
B. Congenital syphilis
C. Stargardt disease
D. Rhinoscleroma

Explanation: ***Diabetes mellitus*** - While not directly causing nasal changes, uncontrolled **diabetes** can significantly impair general tissue health and immune response, contributing to chronic infections and slow healing in the nasal passages. - This can predispose individuals to severe **atrophic rhinitis** and secondary infections, leading to extensive encrustations and a "woody" induration of the external nose due to persistent inflammation and fibrosis. *Stargardt disease* - This is a form of inherited **macular degeneration** primarily affecting vision. - It has no known association with nasal mucosal changes, crusting, or external nasal induration. *Congenital syphilis* - Can cause "snuffles" in infants, which is a severe rhinitis with discharge and obstruction, and may lead to a **saddle nose deformity** due to cartilage destruction. - However, it does not typically present with the specific combination of **atrophic dry mucosa**, extensive encrustations, and a **woody hard external nose** as described in the adult presentation. *Rhinoscleroma* - Is a chronic granulomatous disease of the nose caused by the bacterium **Klebsiella rhinoscleromatis**, characterized by firm, rubbery, or woody nodules and progressive sclerosis. - Although it causes nasal deformity and obstruction, it initially presents with nasal discharge, crusting, and granuloma formation, not primarily **atrophic dry mucosa** and extensive encrustations across the entire nasal lining, especially in its later, fibrotic stages.

Question 332: All of the following can occur in rheumatic fever except?

A. Mitral regurgitation
B. Mitral stenosis
C. Pericarditis
D. Tricuspid regurgitation as the primary valve lesion (Correct Answer)

Explanation: ***Tricuspid regurgitation as the primary valve lesion*** - While **rheumatic fever** can affect any heart valve, the **tricuspid valve** is rarely affected as the **primary or sole lesion**. - It is most commonly seen in conjunction with more severe **mitral and aortic valve disease**. *Mitral regurgitation* - **Mitral regurgitation** is a common manifestation of **acute rheumatic fever**, occurring due to **inflammation** of the valve leaflets and **chordae tendineae** [1]. - This leads to incompetence of the valve, causing blood to flow back into the left atrium during systole [1]. *Mitral stenosis* - **Mitral stenosis** is a classic **long-term complication** of **rheumatic fever**, typically developing years to decades after the initial acute episode. - Repeated inflammation and scarring lead to **thickening and fusion of the mitral valve leaflets**, restricting blood flow. *Pericarditis* - **Pericarditis**, inflammation of the **pericardium** (the sac surrounding the heart), is a possible manifestation of **rheumatic carditis** in acute rheumatic fever [1]. - It can cause chest pain and may be accompanied by a **pericardial effusion** [1].

Question 333: Which of the following conditions does not typically cause an increase in alpha-fetoprotein (AFP)?

A. Endodermal sinus tumor
B. Bronchial aplasia (Correct Answer)
C. Open spina bifida
D. Dysgerminoma

Explanation: ***Bronchial aplasia*** - **Bronchial aplasia** is a rare congenital malformation of the respiratory system and does not typically involve the production or release of AFP. - This condition is characterized by the **absence or hypoplasia of a bronchus** and is not associated with the embryonic tissues responsible for AFP synthesis. *Open spina bifida* - **Open neural tube defects** like spina bifida lead to leakage of AFP from the fetal cerebrospinal fluid into the amniotic fluid and maternal circulation. - This leakage results in significantly **elevated levels of AFP**, making it a key diagnostic marker. *Endodermal sinus tumor* - **Endodermal sinus tumors**, also known as yolk sac tumors, are malignant germ cell tumors that produce copious amounts of **alpha-fetoprotein (AFP)**. - These tumors mimic the embryonic yolk sac, which is a primary site of AFP synthesis during fetal development. *Dysgerminoma* - **Dysgerminoma** is a germ cell tumor that typically does *not* produce AFP; instead, it is often associated with elevated levels of **lactate dehydrogenase (LDH)** and **human chorionic gonadotropin (hCG)** in some cases. - While AFP can be mildly elevated in mixed germ cell tumors containing dysgerminoma components, pure dysgerminoma is not a primary source of AFP production.

Question 334: Most common presentation of Peutz-Jeghers syndrome is

A. Increased risk of pancreatic cancer
B. Increased risk of melanoma
C. Intussusception due to hamartomatous polyps (Correct Answer)
D. Bowel malabsorption issues

Explanation: ***Intussusception due to hamartomatous polyps*** - **Intussusception** is a common and often the first clinical manifestation of Peutz-Jeghers syndrome, caused by the characteristic **hamartomatous polyps** acting as a lead point [1]. - These polyps, particularly in the small intestine, can prolapse into an adjacent segment of the bowel, leading to bowel obstruction and pain [1]. *Increased risk of pancreatic cancer* - While patients with Peutz-Jeghers syndrome do have an **increased risk of various cancers**, including pancreatic cancer, this is not the most common initial presentation [2]. - Cancer development typically occurs later in life, whereas intussusception can occur in childhood or early adulthood. *Increased risk of melanoma* - Peutz-Jeghers syndrome is primarily associated with an increased risk of gastrointestinal and other visceral cancers, not typically with an **increased risk of melanoma**. - The distinctive **mucocutaneous pigmentation** seen in PJS can be mistaken for other pigmented lesions, but it is not indicative of melanoma risk. *Bowel malabsorption issues* - Although the polyps can sometimes cause bleeding or abdominal pain, **significant malabsorption** is not a characteristic or common direct presentation of Peutz-Jeghers syndrome. - Malabsorption might be a secondary complication in severe, rare cases following extensive resections or severe chronic inflammation, but not a primary presentation.

Question 335: Which of the following is not considered a premalignant condition?

A. Barrett's esophagus
B. Hiatus hernia (Correct Answer)
C. Achalasia
D. Plummer Vinson syndrome

Explanation: ***Hiatus hernia*** - A **hiatus hernia** involves the protrusion of a part of the stomach into the chest through the **esophageal hiatus** in the diaphragm [1]. - While it can cause **gastroesophageal reflux disease (GERD)**, which is a risk factor for Barrett's esophagus, a hiatus hernia itself is not considered a premalignant condition [1]. *Barrett's esophagus* - **Barrett's esophagus** is a condition where the normal squamous epithelium of the lower esophagus is replaced by **columnar metaplasia**, which is a direct precursor to esophageal adenocarcinoma. - This change occurs due to chronic exposure to **acid reflux** in GERD, making it a significant premalignant condition. *Achalasia* - **Achalasia** is an esophageal motility disorder characterized by impaired relaxation of the lower esophageal sphincter and absence of peristalsis, leading to food retention. - Chronic inflammation and irritation from retained food and fluids significantly increases the risk of developing **esophageal squamous cell carcinoma**, hence it is a premalignant condition. *Plummer Vinson syndrome* - **Plummer-Vinson syndrome** is a **triad** of iron deficiency anemia, esophageal web, and dysphagia. - This syndrome is associated with an increased risk of developing **squamous cell carcinoma** of the esophagus and pharynx due to chronic irritation and inflammation, making it a premalignant condition.

Question 336: Plasma cholinesterase levels are affected by various conditions. Which of the following conditions does not typically reduce plasma cholinesterase levels?

A. Pregnancy
B. Liver disease
C. Malnutrition
D. Chronic renal failure (Correct Answer)

Explanation: ***Chronic renal failure*** - While chronic renal failure can cause various metabolic derangements, it does not typically lead to a significant **reduction in plasma cholinesterase levels**. - Plasma cholinesterase is primarily synthesized in the liver, and its levels are more directly impacted by conditions affecting **liver function** or **protein synthesis** [1]. *Pregnancy* - **Plasma cholinesterase levels** are known to decrease during normal pregnancy, particularly in the third trimester. - This reduction is thought to be due to **hormonal changes** and possibly increased plasma volume. *Liver disease* - Since plasma cholinesterase is synthesized in the **liver**, severe **liver disease** (e.g., cirrhosis, acute hepatitis) significantly impairs its production [1]. - This leads to a marked **reduction in circulating enzyme levels**, which can affect drug metabolism [1]. *Malnutrition* - **Severe malnutrition**, especially protein-calorie malnutrition, can lead to decreased synthesis of many proteins, including plasma cholinesterase. - This is because the body lacks the necessary **amino acids** for enzyme production.

Question 337: What is the most common cause of left-sided vocal cord palsy?

A. Vocal cord surgery complication (Correct Answer)
B. Mitral stenosis
C. Thyroid cancer
D. Left hilar bronchial carcinoma

Explanation: ***Vocal cord surgery complication*** - Damage to the **recurrent laryngeal nerve** during surgeries like thyroidectomy or parathyroidectomy is a common iatrogenic cause of vocal cord palsy [1]. - While other conditions can cause left-sided palsy, surgical trauma is a very frequent and direct cause due to the nerve's proximity [1]. *Left hilar bronchial carcinoma* - A left hilar bronchial carcinoma can compress or invade the **left recurrent laryngeal nerve**, leading to left vocal cord palsy. - This is a significant cause, but iatrogenic injury is often more prevalent overall. *Mitral stenosis* - Severe **mitral stenosis** can lead to an enlarged left atrium, which may compress the left recurrent laryngeal nerve, causing vocal cord palsy (Ortner's syndrome). - This is a less common cause compared to other etiologies, and often seen in advanced cardiac disease. *Thyroid cancer* - **Thyroid cancer** can invade the recurrent laryngeal nerve directly, leading to vocal cord paralysis [1]. - While a direct cause, its incidence as 'the most common cause' is often less than iatrogenic injury by surgeons for benign or malignant thyroid conditions [1].

Question 338: Cullen's sign is associated with which of the following?

A. Bluish discolouration in the umbilicus (Correct Answer)
B. Subcutaneous fat necrosis
C. Bluish discolouration of the flanks
D. Migratory thrombophlebitis

Explanation: ***Bluish discolouration in the umbilicus*** - **Cullen's sign** is characterized by **periumbilical ecchymosis** or bluish discoloration around the umbilicus. - It is a sign of **retroperitoneal hemorrhage**, often associated with **acute pancreatitis** [1], but also can be caused by ruptured ectopic pregnancy [2] or aortic rupture. *Subcutaneous fat necrosis* - This condition involves the death of fat cells under the skin, often presenting as firm, red nodules or plaques. - While it can occur in various contexts, it is not specifically known as Cullen's sign and does not inherently involve umbilical discoloration. *Bluish discolouration of the flanks* - This description refers to **Grey Turner's sign**, which is ecchymosis or discoloration of the flanks. - **Grey Turner's sign** is also indicative of retroperitoneal hemorrhage, often seen in severe acute pancreatitis, but it is distinct from Cullen's sign which is periumbilical. *Migratory thrombophlebitis* - This condition involves recurrent inflammation and thrombosis of superficial veins in different locations over time. - It is also known as **Trousseau's sign of malignancy** and is associated with visceral cancers, particularly pancreatic adenocarcinoma, but it is unrelated to Cullen's sign.

Question 339: All statements about Plummer-Vinson syndrome are true except.

A. Common in females and associated with iron deficiency
B. Commonly leads to carcinoma in lower third of oesophagus (Correct Answer)
C. Common with iron deficiency
D. Considered a premalignant condition for upper esophageal carcinoma

Explanation: ***Commonly leads to carcinoma in lower third of oesophagus*** - Plummer-Vinson syndrome is associated with an increased risk of **squamous cell carcinoma** of the **upper esophagus** (postcricoid region), not the lower third. - Adenocarcinoma, more common in the lower esophagus, is usually linked to Barrett's esophagus. *Common with iron deficiency* - **Iron deficiency anemia** is a hallmark feature and a prerequisite for diagnosing Plummer-Vinson syndrome. [1] - Iron deficiency is thought to contribute to the formation of esophageal webs and mucosal changes. *Common in females and associated with iron deficiency* - This syndrome predominantly affects **middle-aged women** who have long-standing, severe iron deficiency anemia. [1] - The gender predilection is a classic epidemiological characteristic of the syndrome. *Considered a premalignant condition for upper esophageal carcinoma* - Plummer-Vinson syndrome is recognized as a **premalignant condition**, increasing the risk of developing **squamous cell carcinoma** in the postcricoid region (upper esophagus). - Regular surveillance and iron supplementation are important due to this malignant potential.

Question 340: Deficiency of which of the following causes a perioral rash, gonadal atrophy, neuritis, and pigmentation of skin creases?

A. Zinc (Correct Answer)
B. Selenium
C. Copper
D. Magnesium

Explanation: ***Zinc*** - **Zinc deficiency** can lead to acrodermatitis enteropathica, which manifests with a characteristic **perioral and acral rash** [1]. - Other common symptoms include **gonadal atrophy**, hair loss, **neuritis**, and impaired immune function [1]. *Copper* - **Copper deficiency** can cause neurological problems, anemia, and bone abnormalities. - It is not typically associated with **perioral rashes** or **gonadal atrophy**. *Selenium* - **Selenium deficiency** is linked to Keshan disease (cardiomyopathy) and skeletal muscle weakness. - It does not cause the specific constellation of symptoms described, such as **perioral rash** or **gonadal atrophy**. *Magnesium* - **Magnesium deficiency** primarily leads to neuromuscular hyperexcitability, such as tremors and tetany, or cardiac arrhythmias. - It is not known to cause a **perioral rash** or **gonadal atrophy**.

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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