Viral Keratitis Indian Medical PG Practice Questions and MCQs
Practice Indian Medical PG questions for Viral Keratitis. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Viral Keratitis Indian Medical PG Question 1: A patient presents with eye pain, redness, and blurred vision after sleeping in contact lenses. Fluorescein staining reveals a corneal ulcer. What is the most appropriate management?
- A. Topical antibiotics (Correct Answer)
- B. Oral antibiotics
- C. Topical corticosteroids
- D. Saline irrigation
Viral Keratitis Explanation: ***Topical antibiotics***
- A **corneal ulcer**, especially in a contact lens wearer, is highly suspicious for **bacterial infection**, necessitating immediate and aggressive topical antibiotic therapy.
- **Broad-spectrum antibiotics** (e.g., fluoroquinolones) are often started empirically and adjusted based on culture results.
*Oral antibiotics*
- **Systemic antibiotics** are generally not indicated for uncomplicated bacterial corneal ulcers, as they don't achieve sufficient concentrations in the cornea to be effective.
- They may be considered for severe cases with limbal involvement or scleral extension, or if there is a concern for concurrent systemic infection.
*Topical corticosteroids*
- **Corticosteroids** are contraindicated in the initial management of suspected infectious corneal ulcers because they can suppress the immune response and worsen the infection.
- They may be cautiously used later in treatment to reduce inflammation after the infection is well-controlled.
*Saline irrigation*
- While helpful for removing foreign bodies or debris, **saline irrigation alone** is insufficient to treat a bacterial corneal ulcer.
- It does not eradicate the infection and delaying definitive antibiotic treatment can lead to severe complications.
Viral Keratitis Indian Medical PG Question 2: Corneal sensations are decreased in all of the following conditions except:
- A. Neuroparalytic keratitis
- B. Leprosy
- C. Herpetic keratitis
- D. Recurrent corneal erosion syndrome (Correct Answer)
Viral Keratitis Explanation: ***Recurrent corneal erosion syndrome***
- This condition involves **defective adhesion** of the corneal epithelium to the underlying Bowman's layer and basement membrane, leading to sudden, severe pain upon waking.
- While it causes **pain** and **epithelial defects**, it does not primarily involve nerve damage or decreased corneal sensation; rather, episodes are often very painful due to exposed nerve endings.
*Herpetic keratitis*
- Caused by the **herpes simplex virus (HSV)**, which can infect the trigeminal nerve and lead to **trophic changes** in the cornea.
- This viral infection often results in **significant reduction** or loss of corneal sensation, making the eye more vulnerable to trauma and delayed healing.
*Neuroparalytic keratitis*
- This condition is also known as **neurotrophic keratitis** and results from damage to the **trigeminal nerve**, which supplies sensation to the cornea.
- Loss of corneal sensation leads to impaired reflex tearing and blinking, making the cornea susceptible to epithelial breakdown and ulceration due to lack of protective mechanisms.
*Leprosy*
- In ocular leprosy, the **Mycobacterium leprae** directly invades the ciliary nerves, significantly impairing corneal sensation.
- This reduced sensation in leprosy patients increases the risk of **corneal ulcers** and opacification due to undetected foreign bodies and trauma.
Viral Keratitis Indian Medical PG Question 3: Herpes zoster ophthalmicus is caused by:
- A. VZV (Correct Answer)
- B. HPV
- C. HSV
- D. CMV
Viral Keratitis Explanation: ***Correct Answer: VZV***
- **Varicella-zoster virus (VZV)** is the causative agent of **herpes zoster ophthalmicus**, which is a reactivation of the virus in the ophthalmic division of the trigeminal nerve.
- The initial infection with VZV causes **chickenpox (varicella)**, and the virus remains dormant in sensory ganglia to reactivate later as shingles.
*Incorrect - HPV*
- **Human papillomavirus (HPV)** is primarily known for causing **warts** and is a significant risk factor for certain **cancers**, particularly cervical cancer.
- HPV does not cause vesicular rashes associated with herpes zoster or ophthalmic involvement.
*Incorrect - HSV*
- **Herpes simplex virus (HSV)** causes different forms of herpes infections, such as **oral (cold sores)** and **genital herpes**, and can also cause keratitis but is distinct from zoster ophthalmicus.
- While HSV can affect the eye, leading to **herpes simplex keratitis**, it produces a different clinical picture and does not involve the dermatomal rash characteristic of zoster.
*Incorrect - CMV*
- **Cytomegalovirus (CMV)** is a common virus often causing asymptomatic infections in healthy individuals.
- In immunocompromised patients, CMV can cause serious diseases, including **retinitis**, but it does not cause herpes zoster ophthalmicus.
Viral Keratitis Indian Medical PG Question 4: Interstitial keratitis is associated with all of the following except:
- A. Syphilis
- B. Acanthamoeba (Correct Answer)
- C. Chlamydia Trachomatis
- D. Herpes Zoster Virus (HZV)
Viral Keratitis Explanation: ***Acanthamoeba***
- **Acanthamoeba keratitis** is a **suppurative keratitis** characterized by a painful, ring-shaped infiltrate with epithelial ulceration, typically associated with contact lens use and contaminated water exposure.
- It causes **ulcerative stromal inflammation**, not the **non-ulcerative deep stromal inflammation** that characterizes classic interstitial keratitis.
- **This is NOT a cause of interstitial keratitis.**
*Syphilis*
- **Congenital syphilis** is the **CLASSIC cause** of bilateral **interstitial keratitis**, often presenting in late childhood with "salmon patch" appearance, photophobia, lacrimation, and eventual ghost vessels.
- The inflammation is **non-ulcerative and chronic**, affecting the **deep corneal stroma** with preservation of epithelium.
- This is the most important association with interstitial keratitis to remember.
*Chlamydia Trachomatis*
- **Chlamydia trachomatis** causes **trachoma**, a chronic keratoconjunctivitis leading to **superficial keratitis with pannus formation** (superficial vascularization from the limbus).
- The corneal involvement in trachoma is **superficial**, not the deep stromal inflammation seen in classic interstitial keratitis.
- While listed in some references, **Chlamydia is NOT a standard cause of interstitial keratitis** in major ophthalmology textbooks.
- **Note:** This option is potentially debatable, but Acanthamoeba is the more definitively incorrect answer.
*Herpes Zoster Virus (HZV)*
- **Herpes zoster ophthalmicus** can lead to **interstitial keratitis** and **disciform keratitis** (immune-mediated stromal inflammation with disc-shaped corneal edema).
- Similarly, **HSV (Herpes Simplex Virus)** causes stromal keratitis, a form of interstitial keratitis.
- The corneal involvement includes **deep stromal inflammation, scarring**, and potential neurotrophic changes leading to vision impairment.
Viral Keratitis Indian Medical PG Question 5: Which virus is most commonly associated with disciform keratitis?
- A. Rubella Virus
- B. Herpes Simplex Virus (HSV) (Correct Answer)
- C. Human Immunodeficiency Virus (HIV)
- D. Hepatitis B Virus (HBV)
Viral Keratitis Explanation: ***Herpes Simplex Virus (HSV)***
- **HSV** is the most common cause of **infectious disciform keratitis**, often following a primary ocular HSV infection or reactivation.
- Disciform keratitis caused by HSV is a form of **immune-mediated stromal keratitis**, characterized by corneal edema, inflammation, and potential vision loss.
*Rubella Virus*
- While Rubella can cause ocular manifestations, such as **congenital cataracts** and **glaucoma** in infants, it is not typically associated with disciform keratitis in adults or children.
- **Congenital rubella syndrome** is the primary context for ophthalmic issues related to this virus.
*Human Immunodeficiency Virus (HIV)*
- HIV can lead to various ocular complications, such as **CMV retinitis**, **Kaposi's sarcoma** of the conjunctiva, and **HIV retinopathy**.
- However, HIV itself is **not directly linked** to disciform keratitis.
*Hepatitis B Virus (HBV)*
- HBV infection primarily affects the **liver** and is not commonly associated with direct ocular infections like keratitis.
- Ocular manifestations are rare and often nonspecific, mainly related to systemic immune responses rather than direct viral replication in the eye.
Viral Keratitis Indian Medical PG Question 6: A 30 year old man presents to the clinic with pain in the eye, watering, redness, and photophobia. Examination of his eyes shows circumcorneal congestion and keratic precipitates. Assertion: Keratic precipitates (KPs) are proteinaceous deposits that can occur in various patterns on the corneal endothelium. Reason: Mutton fat KPs are seen in granulomatous iridocyclitis and are composed of epithelioid cells and macrophages.
- A. Both Assertion and Reason are true, and Reason is the correct explanation for Assertion
- B. Both Assertion and Reason are true, and Reason is not the correct explanation for Assertion (Correct Answer)
- C. Assertion is true, but Reason is false
- D. Assertion is false but reason is true
Viral Keratitis Explanation: ***Both Assertion and Reason are true, and Reason is not the correct explanation for Assertion***
**Why both statements are true:**
- The **Assertion** is correct: Keratic precipitates (KPs) are inflammatory cell and protein deposits that adhere to the **corneal endothelium** and can present in various patterns including fine dusty KPs, medium-sized KPs, and large mutton fat KPs.
- The **Reason** is also correct: **Mutton fat KPs** are characteristic of **granulomatous anterior uveitis** (granulomatous iridocyclitis) and consist of aggregations of **epithelioid cells and macrophages**, appearing as large, greasy, white deposits.
**Why Reason does NOT explain Assertion:**
- The Reason describes a **specific type** of KP (mutton fat) and its cellular composition in one particular form of inflammation (granulomatous).
- The Assertion makes a **general statement** about KPs occurring in various patterns.
- The Reason does not explain **why** KPs can occur in various patterns or what determines these different patterns - it only describes one specific pattern.
*Incorrect: Both true with Reason explaining Assertion* - The Reason is too specific and only describes one type of KP, not the general mechanism of pattern variation.
*Incorrect: Assertion true, Reason false* - Both statements are medically accurate and well-established in ophthalmology literature.
*Incorrect: Assertion false, Reason true* - KPs are well-documented deposits on the corneal endothelium in various forms of uveitis, making the Assertion true.
Viral Keratitis Indian Medical PG Question 7: Which of the following is a contraindication to topical steroids?
- A. Dendritic ulcer (Correct Answer)
- B. Herpetic stromal keratitis without epithelial defect
- C. Elevated intraocular pressure
- D. Non-infectious anterior uveitis
Viral Keratitis Explanation: ***Dendritic ulcer***
- A **dendritic ulcer** is characteristic of **herpes simplex keratitis**, which is an active viral infection of the cornea.
- **Topical steroids** are contraindicated because they can suppress the immune response, leading to viral replication, corneal melt, and potentially severe vision loss or perforation.
*Herpetic stromal keratitis without epithelial defect*
- In cases of **stromal keratitis**, where the infection is deeper and an intact epithelium is present, topical steroids may be used cautiously in conjunction with antiviral agents to reduce inflammation and scarring.
- The primary concern with steroids in herpes simplex keratitis is activating viral replication in the presence of an **epithelial defect**, which is not present here.
*Elevated intraocular pressure*
- **Elevated intraocular pressure** is a known side effect of topical steroid use, especially with prolonged administration, but it is not an absolute contraindication in itself.
- It necessitates careful monitoring and may require concurrent glaucoma treatment, but the primary condition needing steroids may still warrant their use.
*Non-infectious anterior uveitis*
- **Topical corticosteroids** are the **mainstay of treatment** for non-infectious anterior uveitis to reduce inflammation and prevent complications such as synechiae and vision loss.
- The benefits of controlling inflammation in uveitis generally outweigh the risks associated with judicious steroid use.
Viral Keratitis Indian Medical PG Question 8: In a patient with acute anterior uveitis presenting with raised intraocular pressure, the PRIMARY treatment should be:
- A. Topical steroids (Correct Answer)
- B. Topical beta-blockers
- C. Cycloplegics
- D. Miotics
Viral Keratitis Explanation: ***Topical steroids***
- **Topical corticosteroids** are the primary treatment for **anterior uveitis** to reduce inflammation, which is the underlying cause of both the uveitis and often the raised IOP.
- While IOP is elevated, managing the inflammation with steroids is crucial, as the inflammation itself can lead to secondary **IOP elevation** due to trabecular meshwork dysfunction or synechiae formation.
*Topical beta-blockers*
- **Topical beta-blockers** are used to lower intraocular pressure, but they do not address the underlying **inflammation** in acute anterior uveitis.
- Using them alone without treating the inflammation can lead to progression of the uveitis and further ocular damage.
*Cycloplegics*
- **Cycloplegics** (e.g., atropine, cyclopentolate) are important adjuncts in acute anterior uveitis to relieve pain from ciliary spasm and prevent posterior synechiae formation by dilating the pupil.
- They do not, however, treat the **inflammation** directly or primarily address the elevated intraocular pressure.
*Miotics*
- **Miotics** (e.g., pilocarpine) **constrict the pupil**, which can worsen symptoms in acute anterior uveitis by increasing ciliary body spasm and potentially increasing the risk of posterior synechiae formation.
- They are contraindicated in acute anterior uveitis as they exacerbate pain and inflammation, and do not treat the underlying cause.
Viral Keratitis Indian Medical PG Question 9: 1% atropine is given in uveitis to:
- A. Cause miosis and prevent formation of posterior synechiae
- B. Cause mydriasis and prevent formation of anterior synechiae
- C. Cause mydriasis and prevent formation of posterior synechiae (Correct Answer)
- D. Reduce inflammation and relieve pain
Viral Keratitis Explanation: ***Cause mydriasis and prevent formation of posterior synechiae***
- **Atropine** is a **cycloplegic** and mydriatic agent used in uveitis to dilate the pupil, which helps to separate the iris from the lens.
- This dilation is crucial in preventing the formation of **posterior synechiae** (adhesions between the iris and the anterior lens capsule), which can lead to complications such as pupil distortion, secondary glaucoma, and cataracts.
*Cause miosis and prevent formation of posterior synechiae*
- **Atropine** causes **mydriasis** (pupil dilation), not miosis (pupil constriction).
- Miosis would increase the risk of posterior synechiae formation by bringing the iris and lens closer together.
*Cause mydriasis and prevent formation of anterior synechiae*
- **Anterior synechiae** are adhesions between the iris and the cornea, which are less commonly affected by atropine in uveitis compared to posterior synechiae.
- While atropine causes mydriasis, its primary role in preventing synechiae formation in uveitis is directed at **posterior synechiae**.
*Reduce inflammation and relieve pain*
- While **atropine** can indirectly relieve pain by reducing **ciliary spasm** (a component of uveitic pain), its primary mechanism of action is not to reduce inflammation.
- **Corticosteroids** are the main treatment for reducing inflammation in uveitis.
Viral Keratitis Indian Medical PG Question 10: Topical antiviral drugs are not indicated in:
- A. Metaherpetic ulcer (Correct Answer)
- B. Dendritic ulcer
- C. Stromal necrotizing keratitis
- D. All of the options
Viral Keratitis Explanation: ***Metaherpetic ulcer***
- Metaherpetic ulcers are **neurotrophic ulcers** that develop as a result of chronic epithelial damage and impaired healing after a herpes simplex virus (HSV) infection, but they are not an active viral replication process.
- Topical antivirals are ineffective because there is **no replicating virus** to target; management focuses on promoting corneal healing and preventing secondary infections.
*Dendritic ulcer*
- A dendritic ulcer is a classic sign of **active HSV keratitis** with replicating virus in the epithelial cells.
- Topical antiviral drugs (e.g., acyclovir, ganciclovir) are the **first-line treatment** to inhibit viral replication and promote epithelial healing.
*Stromal necrotizing keratitis*
- This condition involves **inflammation and necrosis** in the corneal stroma, often due to an immune reaction to HSV antigens rather than direct viral invasion.
- While topical antivirals may be used to suppress any residual replicating virus, **topical corticosteroids are often necessary** to control the inflammation, and close monitoring is crucial due to the risk of steroid-induced complications.
*All of the options*
- This option is incorrect because topical antiviral drugs *are* indicated for **dendritic ulcers** and sometimes as adjunctive therapy for **stromal necrotizing keratitis** where active viral replication might be contributing.
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