This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: None, Subject name: Medicine
All are TRUE about the clinical features of polycythemia rubra vera, EXCEPT: 
Select and explain. 
A. Hepatomegaly is the initial presenting sign, B. Aquagenic pruritus present, C. Veigo, tinnitus, headache and visual disturbances are due to hyperviscosity, D. Systolic hypeension is a feature of increased red cell mass
A: Hepatomegaly is the initial presenting sign
Answer: A: Hepatomegaly is the initial presenting sign 
Explanation: Polycythemia rubra vera clinical features: Splenomegaly may be the initial presenting sign Aquagenic pruritus Hyperviscosity leads to veigo, tinnitus, headache, visual disturbances, and transient ischemic attacks (TIAs). Systolic hypeension is due to red cell mass elevation. Venous or aerial thrombosis may be the presenting manifestation of PV. Erythromelalgia, is a complication of the thrombocytosis Hyperuricemia with secondary gout, uric acid stones, and symptoms due to hypermetabolism can also complicate the disorder. Ref: Harrison, E-18, P-899