[MCQ] Approach to the Patient with Disease of the Respiratory System- Part 2

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Approach to the Patient with Disease of the Respiratory System- Part 2

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Question 1

Clubbing of the digits is not a sign of ?

A	COPD
B	Crohn’s disease
C	Bacterial endocarditis
D	Interstitial lung disease

Question 1 Explanation:

Clubbing of the digits is not a sign of COPD, and its presence should alert clinician to initiate an investigation for causes of clubbing. Even cyanosis is a late finding in cor pulmonale & is secondary to a low cardiac output with systemic vasoconstriction & ventilation-perfusion mismatches in lung

Question 2

Which of the following is a feature of Hypertrophic osteoarthropathy (HOA) ?

A	Clubbing of digits
B	Periosteal new bone formation
C	Synovial effusions
D	All of the above

Question 2 Explanation:

HOA is characterized by clubbing of digits and, in more advanced stages, by periosteal new bone formation and synovial effusions

Question 3

Which of the following about primary hypertrophic osteoarthropathy is false ?

A	Autosomal dominant disorder
B	Periosteal new bone formation
C	Smooth & undulating periosteal surface
D	Hyperhydrosis

Question 3 Explanation:

Primary or idiopathic hypertrophic osteoarthropathy is an autosomal dominant disorder characterized by periosteal new bone formation of distal extremities with irregular periosteal surface, clubbing, hyperhydrosis, thickening of skin of face & forehead, progressive enlargement of hands & feet, and arthralgias. In secondary hypertrophic osteopathy due to pulmonary disorders, exuberant periosteal new bone formation occurs with smooth and undulating periosteal surface

Question 4

Role of which of the following explains acquired HOA ?

A	RBC
B	Platelets
C	WBC
D	All of the above

Question 4 Explanation:

Recent studies have suggested a role for platelets in the development of HOA. Megakaryocytes & large platelet particles, present in venous circulation, get fragmented in their passage through normal lung. In patients with cyanotic congenital heart disease and in right-to-left shunts, these large platelet particles bypass lung and reach distal extremities, where they interact with endothelial cells. Platelet-endothelial activation in distal portion of extremities results in release of plateletderived growth factor (PDGF) leading to proliferation of connective tissue & periosteum. Stimulation of fibroblasts by PDGF & transforming growth factor results in cell growth and collagen synthesis. Elevated plasma levels of von Willebrand factor antigen have been found in patients with both primary and secondary forms of HOA, indicating endothelial activation or damage.

Question 5

Touraine-Solente-Golé syndrome refers to ?

A	Primary or familial hypertrophic osteoarthropathy
B	Hemophilic arthropathy
C	Arthropathy of acromegaly
D	Arthropathy of hemochromatosis

Question 5 Explanation:

Primary or familial HOA is called pachydermoperiostitis or Touraine-Solente-Golé syndrome. Usually begins insidiously at puberty, this autosomal dominant trait with variable expression and is nine times more common in boys than in girls

Question 6

Which of the following is not a feature of primary hypertrophic osteoarthropathy (HOA) ?

A	Clubbing
B	Periostitis
C	Ptosis
D	Anhidrosis

Question 6 Explanation:

Primary HOA is characterized by clubbing, periostitis, and unusual skin features. The skin becomes thickened and coarse. Deep nasolabial folds develop, and the forehead may become furrowed. Patients may have heavy-appearing eyelids and ptosis. The skin is often greasy, and there may be excessive sweating of the hands and feet

Question 7

Cutis verticis gyrata is a feature of ?

A	Scleroderma
B	Primary HOA
C	Diabetes mellitus
D	Syphilis

Question 7 Explanation:

In primary HOA, skin over scalp becomes very thick & corrugated (cutis verticis gyrata).

Question 8

Associated abnormalities observed in primary HOA include all except ?

A	Hypertrophic gastropathy
B	Synovial hypertrophy
C	Bone marrow failure
D	Female escutcheon

Question 8 Explanation:

Associated abnormalities in primary HOA include hypertrophic gastropathy, bone marrow failure, female escutcheon, gynecomastia, and cranial suture defects. Noninflammatory effusions occur in wrists, knees & ankles. Synovial hypertrophy is not found

Question 9

The sensation experienced by patient in clubbed fingers is ?

A	Burning
B	Itching
C	Tingling
D	All of the above

Question 10

Fishman’s classification is used for ?

A	Cyanosis
B	Anemia
C	Clubbing
D	Jaundice

Question 10 Explanation:

An objective measurement of finger clubbing can be made by determining the diameter at the base of the nail and at the distal interphalangeal joint of all 10 digits. Clubbing is present when the sum of the individual digit ratios is >10.

Question 11

Which of the following is present in clubbing ?

A	Periungual erythema
B	Drumstick appearance
C	Hyperextended distal interphalangeal joint
D	All of the above

Question 11 Explanation:

Marked periungual erythema is usually present. When clubbing is advanced, the finger may have a drumstick appearance, and the distal interphalangeal joint can be hyperextended. Periosteal involvement in the distal extremities may produce a burning or deep-seated aching pain. The pain can be quite incapacitating and is aggravated by dependency and relieved by elevation of the affected limbs. The overlying soft tissue may be swollen, and the skin slightly erythematous. Pressure applied over the distal forearms and legs may be quite painful

Question 12

In a patient with clubbing, pain may be present in all of the following joints except ?

A	Ankles
B	Knees
C	Hip
D	Wrists

Question 12 Explanation:

With clubbing, pain & symmetric arthritis-like changes in shoulders, knees, ankles, wrists & elbows is observed.

Question 13

Which of the following is uncommon in secondary HOA ?

A	Excessive sweating
B	Oiliness of the skin
C	Thickening of facial skin
D	All of the above

Question 13 Explanation:

Unlike primary HOA, excessive sweating and oiliness of the skin and thickening of the facial skin are uncommon in secondary HOA

Question 14

Out of the following malignancies, HOA is most common in ?

A	Carcinoma of esophagus
B	Lung metastases
C	Pleural tumors
D	Thymoma

Question 14 Explanation:

HOA is most common in bronchogenic carcinoma and pleural tumors. Lung metastases infrequently cause HOA

Question 15

Unilateral clubbing may be found in which of the following ?

A	Aneurysms of major extremity arteries
B	Infected arterial grafts
C	Arteriovenous fistulas of brachial vessels
D	All of the above

Question 15 Explanation:

Unilateral clubbing is seen in association with aneurysms of major extremity arteries, with infected arterial grafts & with arteriovenous fistulas of brachial vessels.

Question 16

Clubbing of toes but not fingers is found in ?

A	Infected abdominal aortic aneurysm
B	Coarctation of aorta
C	Budd Chiari syndrome
D	Tetralogy of Fallot

Question 17

Clubbing of toes but not fingers is found in ?

A	VSD
B	Patent ductus arteriosus
C	Budd Chiari syndrome
D	Tetralogy of Fallot

Question 17 Explanation:

Clubbing of the toes but not fingers is seen in an infected abdominal aortic aneurysm & PDA. Differential cyanosis refers to cyanotic and clubbed toes but not the fingers

Question 18

Clubbing of a single digit may be found in all except ?

A	Trauma
B	Tophaceous gout
C	Cystic fibrosis
D	Sarcoidosis

Question 18 Explanation:

Clubbing of a single digit may follow trauma, in tophaceous gout and sarcoidosis. With advanced lung disease, clubbing of digits appears in virtually all patients with CF.

Question 19

Which of the following is not a feature of thyroid acropachy ?

A	Hypothyroidism
B	Clubbing
C	Periostitis of hand bones
D	Periostitis of feet bones

Question 19 Explanation:

Hyperthyroidism (Graves’ disease) associated with clubbing & periostitis of bones of hands & feet is called thyroid acropachy. It is strongly associated with thyroid dermopathy

Question 20

Clubbing without cyanosis is frequent in ?

A	Infective endocarditis
B	Inflammatory bowel disease
C	Jackhammer operators
D	All of the above

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See all quizzes of Approach to the Patient with Disease of the Respiratory System at here:

Approach to the Patient with Disease of the Respiratory System- Part 1 | Approach to the Patient with Disease of the Respiratory System- Part 2

1. Clubbing of the digits is not a sign of ?
A. COPD
B. Crohn’s disease
C. Bacterial endocarditis
D. Interstitial lung disease

2. Which of the following is a feature of Hypertrophic osteoarthropathy (HOA) ?
A. Clubbing of digits
B. Periosteal new bone formation

C. Synovial effusions
D. All of the above

3. Which of the following about primary hypertrophi osteoarthropathy is false ?
A. Autosomal dominant disorder
B. Periosteal new bone formation
C. Smooth & undulating periosteal surface
D. Hyperhydrosis

4. Role of which of the following explains acquired HOA ?
A. RBC
B. Platelets
C. WBC
D. All of the above

5. Touraine-Solente-Golé syndrome refers to ?
A. Primary or familial hypertrophic osteoarthropathy
B. Hemophilic arthropathy
C. Arthropathy of acromegaly
D. Arthropathy of hemochromatosis

6. Which of the following is not a feature of primary hypertrophic osteoarthropathy (HOA) ?
A. Clubbing
B. Periostitis
C. Ptosis
D. Anhidrosis

7. Cutis verticis gyrata is a feature of ?
A. Scleroderma
B. Primary HOA
C. Diabetes mellitus

D. Syphilis

8. Associated abnormalities observed in primary HOA include all except ?
A. Hypertrophic gastropathy
B. Synovial hypertrophy
C. Bone marrow failure
D. Female escutcheon

9. The sensation experienced by patient in clubbed fingers is ?
A. Burning
B. Itching
C. Tingling
D. All of the above

10. Fishman’s classification is used for ?
A. Cyanosis
B. Anemia
C. Clubbing
D. Jaundice

11. Which of the following is present in clubbing ?
A. Periungual erythema
B. Drumstick appearance
C. Hyperextended distal interphalangeal joint
D. All of the above

12. In a patient with clubbing, pain may be present in all of the following joints except ?
A. Ankles
B. Knees
C. Hip
D. Wrists

13. Which of the following is uncommon in secondary HOA ?
A. Excessive sweating

B. Oiliness of the skin
C. Thickening of facial skin
D. All of the above

14. Out of the following malignancies, HOA is most common in ?
A. Carcinoma of esophagus
B. Lung metastases
C. Pleural tumors
D. Thymoma
.
15. Unilateral clubbing may be found in which of the following ?
A. Aneurysms of major extremity arteries
B. Infected arterial grafts
C. Arteriovenous fistulas of brachial vessels
D. All of the above

16. Clubbing of toes but not fingers is found in ?
A. Infected abdominal aortic aneurysm
B. Coarctation of aorta
C. Budd Chiari syndrome
D. Tetralogy of Fallot
17. Clubbing of toes but not fingers is found in ?
A. VSD
B. Patent ductus arteriosus
C. Budd Chiari syndrome
D. Tetralogy of Fallot

18. Clubbing of a single digit may be found in all except ?
A. Trauma
B. Tophaceous gout
C. Cystic fibrosis
D. Sarcoidosis

19. Which of the following is not a feature of thyroid acropachy ?
A. Hypothyroidism
B. Clubbing
C. Periostitis of hand bones
D. Periostitis of feet bones

Approach to the Patient with Disease of the Respiratory System

[MCQ] Approach to the Patient with Disease of the Respiratory System- Part 2

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Approach to the Patient with Disease of the Respiratory System- Part 2

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