Scleral Manifestations of Systemic Disease Indian Medical PG Practice Questions and MCQs
Practice Indian Medical PG questions for Scleral Manifestations of Systemic Disease. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Scleral Manifestations of Systemic Disease Indian Medical PG Question 1: What are the extra-articular manifestations of RA?
- A. Pericarditis
- B. Pulmonary fibrosis
- C. Scleritis
- D. All of the options (Correct Answer)
Scleral Manifestations of Systemic Disease Explanation: ***All of the options***
- **Rheumatoid arthritis (RA)** is a systemic inflammatory disease that can affect multiple organs beyond the joints [1]. Therefore, **pericarditis**, **pulmonary fibrosis**, and **scleritis** are all recognized extra-articular manifestations [2].
- The presence of various extra-articular features often indicates more severe or long-standing disease and is associated with increased morbidity and mortality in RA patients.
*Pericarditis*
- **Pericarditis** is a recognized cardiovascular manifestation of RA, involving inflammation of the **pericardium**.
- While many cases are asymptomatic, it can cause chest pain and, rarely, **pericardial effusion** or **constrictive pericarditis**.
*Pulmonary fibrosis*
- **Interstitial lung disease (ILD)**, including **pulmonary fibrosis**, is a significant pulmonary complication of RA [2].
- It can lead to progressive shortness of breath, cough, and is a major cause of morbidity and mortality in RA patients.
*Scleritis*
- **Scleritis** is an ocular manifestation of RA, presenting as severe inflammation of the sclera (the white outer layer of the eyeball) [1].
- It can cause severe pain, redness, and vision changes, and requires prompt treatment to prevent visual impairment [1].
Scleral Manifestations of Systemic Disease Indian Medical PG Question 2: Recurrent anterior uveitis with increased intraocular tension is seen in which of the following conditions?
- A. Posner-Schlossman syndrome (Correct Answer)
- B. Foster-Kennedy syndrome
- C. Vogt-Koyanagi-Harada syndrome
- D. Fuchs heterochromic iridocyclitis
Scleral Manifestations of Systemic Disease Explanation: ***Posner-Schlossman syndrome***
- Characterized by **recurrent, unilateral, non-granulomatous anterior uveitis** associated with markedly **elevated intraocular pressure (IOP)**.
- The condition is also known as **glaucomatocyclitic crisis**, highlighting the episodic inflammation and glaucoma.
- Key features include **acute attacks** lasting hours to weeks with **dramatic IOP elevation** (often >40 mmHg).
*Foster-Kennedy syndrome*
- This syndrome is defined by ipsilateral **optic atrophy**, contralateral **papilledema**, and often **anosmia**, typically due to a frontal lobe tumor.
- It does not involve anterior uveitis or primary elevated intraocular tension.
- This is a neuro-ophthalmologic syndrome, not an inflammatory ocular condition.
*Vogt-Koyanagi-Harada syndrome*
- An autoimmune disorder affecting pigmented tissues, leading to **bilateral granulomatous panuveitis**, often with hearing loss, vitiligo, poliosis, and neurological symptoms.
- While it involves uveitis, it is typically **bilateral and panuveitis**, not recurrent unilateral anterior uveitis.
- IOP may be elevated but not the defining feature with dramatic episodic rises.
*Fuchs heterochromic iridocyclitis*
- A chronic, **unilateral, low-grade anterior uveitis** with characteristic iris heterochromia.
- May have mild IOP elevation but **not recurrent episodic attacks** with marked pressure spikes.
- Inflammation is typically **quiet and chronic** rather than acute and recurrent.
Scleral Manifestations of Systemic Disease Indian Medical PG Question 3: All of the following conditions are associated with raised ANCA, except:
- A. Polyarteritis Nodosa (Correct Answer)
- B. Wegener's granulomatosis
- C. Microscopic Polyangitis
- D. Churg-Strauss syndrome
Scleral Manifestations of Systemic Disease Explanation: ***Polyarteritis Nodosa***
- Polyarteritis Nodosa is not typically associated with **positive ANCA** (Anti-Neutrophil Cytoplasmic Antibodies) and is mainly characterized by systemic vasculitis affecting medium-sized arteries. [1]
- This condition usually presents with symptoms like **weight loss**, **fever**, and **muscle pain**, without the underlying ANCA association. [1]
*Wegener's granulomatosis*
- Also known as Granulomatosis with Polyangiitis, this condition is strongly associated with **c-ANCA** positivity, often targeting **proteinase 3**.
- Clinical features include **respiratory symptoms** and renal involvement, particularly **glomerulonephritis**.
*Microscopic Polyangitis*
- This vasculitis is associated with **p-ANCA** positivity, commonly targeting **myeloperoxidase** (MPO).
- It frequently presents with **pulmonary hemorrhage** and **renal vasculitis**.
*Churg-Strauss syndrome*
- Known as Eosinophilic Granulomatosis with Polyangiitis, it is associated with **p-ANCA** and involves asthma, eosinophilia, and systemic vasculitis [2].
- Typical manifestations include **respiratory involvement** and peripheral neuropathy, further linking it to ANCA positivity.
Scleral Manifestations of Systemic Disease Indian Medical PG Question 4: Which of the following is NOT a connective tissue disorder?
- A. Osteoarthritis
- B. Fibromyalgia
- C. Sjogren's syndrome (Correct Answer)
- D. SLE
Scleral Manifestations of Systemic Disease Explanation: ***Sjogren's syndrome***
- Sjogren's syndrome is an **autoimmune disease** characterized by **dry eyes** and **dry mouth**, resulting from immune-mediated destruction of exocrine glands [1].
- While it can involve multiple organ systems and is classified as a **systemic autoimmune disorder**, it is primarily an **exocrinopathy**, and not exclusively a disorder of connective tissue structure or function.
*Osteoarthritis*
- Osteoarthritis is a **degenerative joint disease** primarily affecting the **articular cartilage** and underlying bone.
- While it involves destruction of cartilage, which is a connective tissue, it is considered a **degenerative rather than a systemic inflammatory or autoimmune connective tissue disorder**.
*Fibromyalgia*
- Fibromyalgia is a chronic pain condition characterized by **widespread musculoskeletal pain**, fatigue, and sleep disturbances, without evidence of inflammation or tissue damage [3].
- It is considered a **central sensitization syndrome** rather than a disorder of the connective tissue itself [3].
*SLE*
- Systemic lupus erythematosus (SLE) is a **prototypical systemic autoimmune connective tissue disorder** affecting multiple organ systems [2].
- It is characterized by **autoantibody production** and immune complex deposition, leading to inflammation and damage in joints, skin, kidneys, and other tissues [2].
Scleral Manifestations of Systemic Disease Indian Medical PG Question 5: Blue sclera is seen in:
- A. Rheumatoid arthritis
- B. Diabetes mellitus
- C. Osteogenesis imperfecta (Correct Answer)
- D. Hypertension
Scleral Manifestations of Systemic Disease Explanation: ***Osteogenesis imperfecta***
- Blue sclera in **osteogenesis imperfecta** is due to the underlying defect in **collagen type I synthesis**, which causes the sclera to be thin and translucent [1].
- This thinness allows the underlying **choroidal pigmentation** to show through, giving it a characteristic blue hue.
*Rheumatoid arthritis*
- While rheumatoid arthritis can affect the eyes (e.g., scleritis, episcleritis), it does not typically cause **blue sclera**.
- Ocular manifestations are usually related to inflammation and can lead to **scleral thinning** or perforation but are distinct from the blue appearance seen in osteogenesis imperfecta.
*Diabetes mellitus*
- Diabetes mellitus can lead to various ocular complications, such as **diabetic retinopathy**, **cataracts**, and **glaucoma**.
- It does not cause a change in the color of the sclera to blue.
*Hypertension*
- Hypertension can affect the eyes, particularly the **retinal vasculature** (hypertensive retinopathy), and increase the risk of conditions like **glaucoma**.
- It has no direct association with the phenomenon of **blue sclera**.
Scleral Manifestations of Systemic Disease Indian Medical PG Question 6: All of the following features may be used to distinguish PAN from microscopic polyangitis, except:
- A. RBC cast in urine
- B. ANCA positivity
- C. HBV infection
- D. Necrotizing vasculitis (Correct Answer)
Scleral Manifestations of Systemic Disease Explanation: ***Necrotizing vasculitis***
- Both **polyarteritis nodosa (PAN)** and **microscopic polyangiitis (MPA)** are characterized by **necrotizing vasculitis**, making it a shared feature rather than a distinguishing one. [1]
- This pathological finding describes the **inflammation** and **necrosis** of vessel walls, which is central to the pathogenesis of both conditions. [1]
*RBC cast in urine*
- **Red blood cell (RBC) casts** in the urine are indicative of **glomerulonephritis**, which is a prominent feature of **microscopic polyangiitis (MPA)** but typically absent in **polyarteritis nodosa (PAN)**. [1]
- The presence of RBC casts points to **renal involvement**, particularly in the small vessels of the glomeruli, which distinguishes MPA's pattern of injury. [1]
*ANCA positivity*
- **Anti-neutrophil cytoplasmic antibodies (ANCAs)**, particularly **p-ANCA (MPO-ANCA)**, are frequently positive in **microscopic polyangiitis (MPA)** but usually negative in **polyarteritis nodosa (PAN)**.
- ANCA positivity helps classify MPA as an **ANCA-associated vasculitis**, a distinction not typically applied to PAN.
*HBV infection*
- **Hepatitis B virus (HBV) infection** is strongly associated with a significant subset of **polyarteritis nodosa (PAN)** cases, whereas this association is rare in **microscopic polyangiitis (MPA)**.
- Serological testing for HBV can therefore help differentiate between the two conditions, with a positive result favoring PAN.
Scleral Manifestations of Systemic Disease Indian Medical PG Question 7: The most common variety of scleritis is:
- A. Non-necrotizing anterior nodular
- B. Anterior necrotizing without inflammation
- C. Anterior necrotizing with inflammation
- D. Non-necrotizing anterior diffuse (Correct Answer)
Scleral Manifestations of Systemic Disease Explanation: ***Non-necrotizing anterior diffuse***
- This is the **most common type of scleritis**, characterized by widespread inflammation of the anterior sclera without tissue loss.
- It presents with **redness**, **pain**, and **tenderness** over a large area of the sclera.
*Non-necrotizing anterior nodular*
- This type features **localized, tender nodules** on the sclera, which are less common than the diffuse form.
- While also non-necrotizing and anterior, the nodular presentation is not the most frequent variety.
*Anterior necrotizing without inflammation*
- This severe form, known as **scleromalacia perforans**, is rare and typically seen in patients with long-standing rheumatoid arthritis.
- It is characterized by **scleral thinning and necrosis** without significant inflammatory signs.
*Anterior necrotizing with inflammation*
- This is a **severe and destructive form** of scleritis associated with significant pain and potential vision loss.
- While serious, it is rare compared to diffuse non-necrotizing anterior scleritis.
Scleral Manifestations of Systemic Disease Indian Medical PG Question 8: Most common type of scleritis among the following is
- A. Necrotizing
- B. Granulomatous
- C. Posterior
- D. Non-necrotizing (Correct Answer)
Scleral Manifestations of Systemic Disease Explanation: ***Non-necrotizing***
- This category, particularly **diffuse non-necrotizing scleritis**, is the most frequently encountered type.
- It is often characterized by widespread inflammation of the sclera without tissue loss.
*Necrotizing*
- This is a severe form of scleritis associated with significant **tissue destruction** and a high risk of vision loss.
- While serious, it is thankfully much rarer than the non-necrotizing forms.
*Granulomatous*
- This term describes a **histopathological feature** of inflammation rather than a distinct clinical type of scleritis.
- Granulomatous inflammation can be seen in various forms of scleritis but is not a primary classification of its most common presentation.
*Posterior*
- **Posterior scleritis** specifically involves inflammation of the sclera behind the equator of the globe.
- It is less common than anterior scleritis and can present with different symptoms such as vision loss or pain with eye movement.
Scleral Manifestations of Systemic Disease Indian Medical PG Question 9: Neurological manifestation of Whipple's disease is:
- A. Encephalopathy (Correct Answer)
- B. Cerebellar ataxia
- C. Seizures
- D. Focal neurological deficits
Scleral Manifestations of Systemic Disease Explanation: ***Encephalopathy***
- **Encephalopathy** is the most common neurological manifestation of Whipple's disease, involving cognitive dysfunction, memory loss, and altered mental status.
- This widespread brain involvement is due to the dissemination of the bacterium *Tropheryma whipplei* throughout the central nervous system.
*Cerebellar ataxia*
- While **cerebellar ataxia** can occur in Whipple's disease, it is less common than encephalopathy and typically presents as part of a broader neurological syndrome rather than an isolated finding.
- Ataxia, when present, often suggests more advanced or disseminated disease.
*Seizures*
- **Seizures** are a less frequent neurological manifestation and are typically seen in cases with focal lesions or significant inflammatory changes within the brain.
- They are not considered the predominant or most common neurological symptom of the disease.
*Focal neurological deficits*
- **Focal neurological deficits**, such as cranial nerve palsies or hemiparesis, can occur but are generally less common than the diffuse cognitive and mental status changes associated with encephalopathy.
- These focal signs usually indicate specific areas of inflammation or granuloma formation.
Scleral Manifestations of Systemic Disease Indian Medical PG Question 10: Vertebra Plana is associated with all of the following conditions except -
- A. Leukemia
- B. Excessive use of systemic steroids
- C. Scheurmanns Disease (Correct Answer)
- D. Histiocytosis X
Scleral Manifestations of Systemic Disease Explanation: ***Scheurmanns Disease***
- **Scheuermann's disease** is characterized by **vertebral wedging** and **kyphosis**, not a complete flattening of the vertebral body (vertebra plana).
- It involves irregularities of the vertebral endplates and Schmorl's nodes, differing from the destructive process seen in vertebra plana.
*Histiocytosis X*
- **Histiocytosis X** (Langerhans cell histiocytosis) can cause destructive lesions in the vertebral body, leading to its collapse and the appearance of **vertebra plana**.
- This condition is common among young children and is associated with eosinophilic granuloma.
*Leukemia*
- **Leukemic infiltration** of bone marrow can weaken vertebral bodies, causing **osteopenia** and eventual collapse, which may present as vertebra plana.
- This is often seen in pediatric patients with acute lymphoblastic leukemia.
*Excessive use of systemic steroids*
- Long-term or excessive use of **systemic corticosteroids** can lead to **osteoporosis**, which weakens bones and makes vertebral bodies prone to compression fractures and collapse into vertebra plana.
- This iatrogenic cause results from the negative impact of steroids on bone formation and increased bone resorption.
More Scleral Manifestations of Systemic Disease Indian Medical PG questions available in the OnCourse app. Practice MCQs, flashcards, and get detailed explanations.
