Clinical Manifestations and Presentation of Diseases Practice Questions

Q: Consider the following clinical features : 1. Raised ICP 2. Seizures 3. Focal deficit 4. Headache Which of the above clinical features are related to most brain tumours?

1, 2, 3 and 4. ***1, 2, 3 and 4*** - All four clinical features—**raised ICP**, **seizures**, **focal neurological deficits**, and **headache**—are commonly associated with brain tumors [1]. - Brain tumors can cause **increased intracranial pressure** through mass effect, edema, or CSF flow obstruction, leading to headaches and, less commonly, seizures [1]. **Focal deficits** result from direct tissue destruction or compression depending on the tumor's location [2]. *2, 3 and 4 only* - This option incorrectly omits **raised ICP**, which is a frequent and significant symptom of brain tumors, contributing to headaches, nausea, vomiting, and altered mental status [1]. - While seizures, focal deficits, and headaches are common, **raised ICP** often underlies many of these symptoms. *1 and 2 only* - This option excludes **focal deficits** and **headache**, both of which are very common presentations of brain tumors. - The specific location of a tumor often dictates **focal deficits** [2], and **headache** is one of the most prevalent symptoms. *1, 2 and 3 only* - This option incorrectly omits **headache**, which is a classic and highly prevalent symptom in patients with brain tumors, often severe and resistant to common analgesics. - Headaches can result from **mass effect**, **increased ICP** [1], or irritation of pain-sensitive structures within the brain.

Q: Heavy menstrual bleeding is a common presentation in which of the following? 1. Clotting factor deficiency 2. Fibroid uterus 3. Adenomyosis 4. Prolactinoma.

1, 2 and 3. ***1, 2 and 3*** - **Clotting factor deficiencies** (e.g., von Willebrand disease, factor XI deficiency) impair normal hemostasis, leading to prolonged and heavy menstrual bleeding. - **Fibroid uterus** causes heavy menstrual bleeding due to increased endometrial surface area, impaired uterine contractility, and dilated underlying vessels. - **Adenomyosis**, characterized by endometrial tissue within the myometrium, leads to an enlarged, boggy uterus and causes heavy and painful menstruation. *2, 3 and 4* - This option correctly identifies fibroid uterus and adenomyosis, which are common causes of heavy menstrual bleeding. - However, **prolactinoma** typically causes **amenorrhea** or oligomenorrhea, not heavy menstrual bleeding, due to its inhibitory effect on gonadotropin-releasing hormone (GnRH). *1, 2 and 4* - While clotting factor deficiency and fibroid uterus are valid causes of heavy menstrual bleeding, **prolactinoma** is an incorrect inclusion. - Prolactinoma often leads to **hypogonadism** and anovulation, resulting in irregular or absent menstrual periods. *1, 3 and 4* - This option includes clotting factor deficiency and adenomyosis, which are causes of heavy menstrual bleeding. - However, **prolactinoma** is not associated with heavy menstrual bleeding; instead, it is known to cause **menstrual irregularities** including amenorrhea.

Q: Which of the following are the extraintestinal manifestations of Crohn's disease related to disease activity?

Arthropathy. **Arthropathy** - **Peripheral arthropathy**, particularly **Type 1 (pauciarticular)**, is directly linked to **Crohn's disease activity**, meaning flares in bowel disease often coincide with flares in joint symptoms. - This form of arthritis typically affects large joints, is transient, and resolves with successful treatment of the underlying intestinal inflammation. *Primary sclerosing cholangitis* - **Primary sclerosing cholangitis (PSC)** is a serious extraintestinal manifestation often associated with Crohn's disease but is **not directly correlated with its activity**. - Its progression is independent of whether the intestinal inflammation is well-controlled. *Pyoderma gangrenosum* - **Pyoderma gangrenosum** is a skin manifestation that can occur in patients with Crohn's disease, but its activity often **does not parallel the severity of the bowel disease**. - While it can be debilitating, effective treatment of Crohn's disease may not always lead to remission of pyoderma gangrenosum. *Amyloidosis* - **Amyloidosis**, specifically **AA amyloidosis**, is a rare but severe complication of chronic inflammatory diseases like Crohn's, resulting from long-term inflammation. - While prolonged, uncontrolled disease activity increases the risk, the **amyloidosis itself does not fluctuate with day-to-day or short-term changes in Crohn's disease activity**.

Q: The following are complications of gall stone except

Haemobilia. ***Haemobilia*** - **Haemobilia** refers to bleeding into the biliary tree, often caused by trauma, surgery, or vascular malformations, and is **not a direct complication of gallstones**. [1] - While gallstones can lead to inflammation and erosion, they typically do not cause bleeding into the bile ducts as a primary complication. *Acute pancreatitis* - **Gallstones** are a common cause of **acute pancreatitis** when a stone obstructs the ampulla of Vater, leading to reflux of bile into the pancreatic duct or obstruction of the pancreatic duct itself [1]. - This obstruction causes premature activation of pancreatic enzymes and autodigestion of the pancreas. *Cholangitis* - **Cholangitis** is an inflammation of the bile ducts, usually caused by bacterial infection, which is often precipitated by an obstruction of the biliary tree, most commonly by **gallstones** [1]. - The obstruction leads to stasis of bile, allowing bacteria to ascend from the duodenum and proliferate. *Biliary enteric fistula* - A **biliary enteric fistula** (e.g., cholecystoduodenal fistula) is a pathological connection between the gallbladder or bile duct and the gastrointestinal tract, which can occur due to chronic inflammation and erosion caused by **gallstones** [1]. - This can lead to gallstone ileus if the stone passes into the bowel and obstructs it [1].

Q: Which one of the following is not a correct statement regarding Raynaud's disease ?

The lower extremity involvement is symmetrical. ***The lower extremity involvement is symmetrical*** - **Raynaud's phenomenon** primarily affects the **fingers and toes**, but it is characterized by **asymmetrical involvement**, affecting different digits or limbs to varying degrees. Symmetrical involvement of the lower extremities is not a typical characteristic. - While it can affect the lower extremities, the hallmark of Raynaud's is its **episodic, asymmetrical, and often acral distribution** in response to triggers. *It commonly affects women* - **Raynaud's phenomenon** is indeed more prevalent in **women** than men, with an estimated prevalence of 5-10% in the general population. - This higher incidence in women is a well-documented epidemiological feature of the condition. *Exposure to cold precipitates vasoconstriction* - **Cold exposure** is the most common and classic trigger for **Raynaud's phenomenon**, leading to an exaggerated **vasoconstrictive response** in the small arteries and arterioles of the extremities. - This extreme vasoconstriction results in the characteristic color changes (pallor, cyanosis, and rubor) due to reduced blood flow. *It is idiopathic* - **Raynaud's disease**, also known as **primary Raynaud's phenomenon**, is indeed considered **idiopathic**, meaning its cause is unknown. - It occurs in the absence of any underlying medical condition, distinguishing it from secondary Raynaud's phenomenon, which is associated with autoimmune diseases or other factors.

Q: Dehydration is not a feature of one of the following diseases :

Cerebral malaria. ***Cerebral malaria*** - This condition is characterized by neurological symptoms, including **impaired consciousness** and **seizures**, resulting from parasitic infection of the brain. - While patients may have fever and fluid loss from sweating, severe **dehydration is not a primary or defining feature** compared to other diseases listed. *MDR-TB* - Patients with **multidrug-resistant tuberculosis (MDR-TB)** often experience constitutional symptoms such as fever, night sweats, and significant anorexia. - These symptoms can lead to **severe weight loss** and **malnutrition**, contributing to chronic dehydration in advanced stages. *Pertussis* - **Pertussis**, or **whooping cough**, is characterized by severe paroxysmal coughing fits accompanied by inspiratory "whoops" and post-tussive vomiting. - The recurrent vomiting, especially in infants and young children, can quickly lead to **significant fluid loss** and **dehydration**. *Cholera* - **Cholera** is an acute diarrheal illness caused by *Vibrio cholerae*, leading to profuse, watery diarrhea and vomiting [1]. - The rapid and severe fluid loss in cholera can cause **life-threatening dehydration** and electrolyte imbalances within hours if untreated [1].

Q: Which of the following conditions may produce "wrist drop" ?

Lead poisoning. ***Lead poisoning*** - **Lead neuropathy** predominantly affects motor nerves, often leading to **wrist drop** and **foot drop** due to involvement of the radial and peroneal nerves, respectively [1]. - The toxic effects of lead interfere with heme synthesis and neuronal function, leading to **demyelination** and axonal degeneration [1]. *Alcoholics* - **Alcoholic neuropathy** typically affects peripheral nerves, causing sensory and motor deficits, often as a **stocking-glove distribution** [3]. - While it can manifest as weakness, classic "wrist drop" is not a hallmark feature; rather, it often involves generalized weakness and sensory loss. *Beriberi* - **Beriberi** is caused by **thiamine (vitamin B1) deficiency** and presents in two main forms: wet (cardiovascular) and dry (neurological). - Dry beriberi causes **peripheral neuropathy** with symmetrical motor and sensory impairment, but **wrist drop** is not a characteristic isolated sign. *Diabetes mellitus* - **Diabetic neuropathy** commonly leads to a **stocking-glove sensory loss** and - Can cause motor weakness, but isolated **wrist drop** [2] is not a typical presentation; rather, it's often polyneuropathy or mononeuropathy multiplex [3].

Q: In a head injury victim, which of the following is the most common initial manifestation of an increasing intra-cranial pressure?

Change in the consciousness level. ***Change in the consciousness level*** - As **intracranial pressure (ICP)** rises due to brain swelling or hematoma, cerebral perfusion is compromised, leading to global brain dysfunction. [1] - This typically manifests first as **subtle changes in arousal**, attention, and orientation, rather than focal neurological deficits. [1] *Ipsilateral pupillary dilatation* - This is a later sign of increasing ICP, specifically indicating **uncal herniation** and compression of the **oculomotor nerve (CN III)**. [1], [2] - While concerning, it usually occurs after changes in consciousness have already been noted. *Contralateral pupillary dilatation* - This is an **atypical finding** in the context of increasing ICP and **unilateral mass effect**. - Pupillary changes due to uncal herniation are typically ipsilateral to the lesion. *Hemiparesis* - **Hemiparesis (weakness on one side of the body)** indicates focal brain compression or damage, often of the **corticospinal tract**. [2] - While it can occur with increasing ICP, it is usually preceded by or occurs concurrently with a decline in the level of consciousness, especially when ICP is rising broadly.

Q: The following constitute the Saint's triad except

Jaundice. ***Jaundice*** - **Jaundice** is not part of Saint's Triad, which describes a common co-occurrence of three specific conditions. - While **gallstones** can cause jaundice, jaundice itself is a symptom, not one of the conditions in the triad. *Colonic diverticulosis* - **Colonic diverticulosis** is one of the three components of Saint's Triad. - It refers to the presence of **diverticula** (small pouches) in the colon. *Gall stones* - **Gallstones** (cholelithiasis) are another key component of Saint's Triad. - This condition involves the formation of **hardened deposits** in the gallbladder. *Hiatus hernia* - **Hiatus hernia** is the third component of Saint's Triad [1]. - It occurs when part of the **stomach protrudes** through the diaphragm into the chest cavity [1].

Q: A young patient presented in the emergency with haematemesis and was found to have massive splenomegaly. The following conditions are associated with the above clinical presentation except

Idiopathic thrombocytopenic purpura. ***Idiopathic thrombocytopenic purpura*** - While ITP can cause **bleeding** (including hematemesis) due to **thrombocytopenia**, it is generally **not associated with massive splenomegaly**. Splenomegaly, if present, is usually mild. - The primary defect in ITP is **immune-mediated platelet destruction**, not a cause of massive splenic enlargement, which typically results from conditions involving portal congestion, infiltrative diseases, or hemolytic processes. *Kala-azar* - **Kala-azar (visceral leishmaniasis)** is notoriously associated with **massive splenomegaly** and can cause **hematemesis** due to complications like **esophageal varices** or coagulopathy. - The parasite (Leishmania donovani) infiltrates the reticuloendothelial system, leading to profound splenomegaly. *Portal hypertension* - **Portal hypertension** is a direct cause of **massive splenomegaly** due to congestion and can lead to **hematemesis** from **ruptured esophageal varices**. - The increased pressure in the portal venous system causes blood to back up into the splenic vein, enlarging the spleen. *Malaria* - **Chronic malaria**, particularly from *Plasmodium falciparum* or *Plasmodium vivax*, can lead to significant, often **massive splenomegaly** (hyperreactive malarial splenomegaly). - While hematemesis is not a primary symptom, severe malaria can cause **coagulopathy** or contribute to **gastrointestinal bleeding** in complicated cases, though massive splenomegaly itself is a prominent feature.

Question 1

Consider the following clinical features :

1. Raised ICP
2. Seizures
3. Focal deficit
4. Headache Which of the above clinical features are related to most brain tumours?

Accepted Answer

1, 2, 3 and 4

Answer

2, 3 and 4 only

Answer

1 and 2 only

Answer

1, 2 and 3 only

Question 2

Heavy menstrual bleeding is a common presentation in which of the following?

1. Clotting factor deficiency
2. Fibroid uterus
3. Adenomyosis
4. Prolactinoma.

Accepted Answer

1, 2 and 3

Answer

2, 3 and 4

Answer

1, 2 and 4

Answer

1, 3 and 4

Question 3

Which of the following are the extraintestinal manifestations of Crohn's disease related to disease activity?

Accepted Answer

Arthropathy

Answer

Primary sclerosing cholangitis

Answer

Pyoderma gangrenosum

Answer

Amyloidosis

Question 4

The following are complications of gall stone except

Accepted Answer

Haemobilia

Answer

Acute pancreatitis

Answer

Cholangitis

Answer

Biliary enteric fistula

Question 5

Which one of the following is not a correct statement regarding Raynaud's disease ?

Accepted Answer

The lower extremity involvement is symmetrical

Answer

It commonly affects women

Answer

Exposure to cold precipitates vasoconstriction

Answer

It is idiopathic

Question 6

Dehydration is not a feature of one of the following diseases :

Accepted Answer

Cerebral malaria

Answer

MDR-TB

Answer

Pertussis

Answer

Cholera

Question 7

Which of the following conditions may produce "wrist drop" ?

Accepted Answer

Lead poisoning

Answer

Alcoholics

Answer

Beriberi

Answer

Diabetes mellitus

Question 8

In a head injury victim, which of the following is the most common initial manifestation of an increasing intra-cranial pressure?

Accepted Answer

Change in the consciousness level

Answer

Ipsilateral pupillary dilatation

Answer

Contralateral pupillary dilatation

Answer

Hemiparesis

Question 9

The following constitute the Saint's triad except

Accepted Answer

Jaundice

Answer

Colonic diverticulosis

Answer

Gall stones

Answer

Hiatus hernia

Question 10

A young patient presented in the emergency with haematemesis and was found to have massive splenomegaly. The following conditions are associated with the above clinical presentation except

Accepted Answer

Idiopathic thrombocytopenic purpura

Answer

Kala-azar

Answer

Portal hypertension

Answer

Malaria

Clinical Manifestations and Presentation of Diseases — MCQs

Clinical Manifestations and Presentation of Diseases — MCQs

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