Scleritis: Posterior Indian Medical PG Practice Questions and MCQs
Practice Indian Medical PG questions for Scleritis: Posterior. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Scleritis: Posterior Indian Medical PG Question 1: Most common type of scleritis is
- A. Diffuse anterior
- B. Nodular anterior
- C. Anterior (Correct Answer)
- D. Posterior
Scleritis: Posterior Explanation: ***Anterior***
- **Anterior scleritis** accounts for approximately **98%** of all scleritis cases, making it the most common type.
- It involves inflammation of the sclera anterior to the **equator of the globe**, visible on external examination.
- Anterior scleritis is further subdivided into **diffuse, nodular,** and **necrotizing** forms based on clinical presentation and severity.
*Diffuse anterior*
- **Diffuse anterior scleritis** is the most common subtype of anterior scleritis, characterized by widespread inflammation.
- While common among anterior types, it represents a subset rather than the overall most common anatomical category.
*Nodular anterior*
- **Nodular anterior scleritis** presents with discrete nodules of inflamed scleral tissue.
- It is less common than diffuse anterior scleritis but more common than necrotizing forms.
*Posterior*
- **Posterior scleritis** is rare, accounting for only about **2%** of all scleritis cases.
- It involves inflammation posterior to the **equator of the globe** and can be difficult to diagnose due to its hidden location, often presenting with pain, proptosis, and vision loss.
Scleritis: Posterior Indian Medical PG Question 2: Most common cause of posterior staphyloma?
- A. Hypermetropia
- B. Conjunctivitis
- C. Myopia (Correct Answer)
- D. Glaucoma
Scleritis: Posterior Explanation: ***Myopia***
- **Posterior staphyloma** is a characteristic degenerative change in **high myopia**, where the sclera thins and bulges posteriorly.
- The rapid and excessive axial elongation of the eyeball in myopia leads to stretching and weakening of the posterior sclera.
*Hypermetropia*
- **Hypermetropia** (farsightedness) is characterized by an eyeball that is too short, leading to light focusing behind the retina.
- It is not associated with the pathological thinning and bulging of the posterior sclera seen in staphyloma.
*conjunctivitis*
- **Conjunctivitis** is an inflammation of the conjunctiva, the membrane lining the inside of the eyelids and covering the sclera.
- It does not involve structural changes to the sclera or retina that would lead to posterior staphyloma.
*Glaucoma*
- **Glaucoma** is a group of diseases that damage the optic nerve, often due to high intraocular pressure, leading to vision loss.
- While it can cause optic disc cupping, it is not directly associated with the development of posterior staphyloma.
Scleritis: Posterior Indian Medical PG Question 3: 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
Scleritis: Posterior 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.
Scleritis: Posterior Indian Medical PG Question 4: A man presents 6 hrs after head injury complaining of mild proptosis and scleral hyperemia:
- A. Caroticocavernous fistula
- B. Retro-orbital hematoma (Correct Answer)
- C. Pneumo-orbit
- D. Orbital cellulitis
Scleritis: Posterior Explanation: ***Retro-orbital hematoma***
- The sudden onset of **proptosis** and **scleral hyperemia** within hours of a head injury is highly suggestive of bleeding behind the eye.
- A **retro-orbital hematoma** causes increased orbital pressure, leading to the forward displacement of the eyeball (proptosis) and conjunctival injection (scleral hyperemia).
*Caroticocavernous fistula*
- This condition involves an abnormal communication between the carotid artery and the cavernous sinus, typically presenting with a **pulsatile proptosis** and a **bruit** over the eye.
- While it can cause proptosis and hyperemia, its onset is usually not as acute as 6 hours post-trauma without being a direct major vessel injury in a recent trauma.
*Pneumo-orbit*
- A pneumo-orbit involves **air entering the orbit**, often following trauma that fractures an orbital wall communicating with a paranasal sinus.
- Symptoms include **periorbital crepitus** and exophthalmos, but scleral hyperemia is not a primary or dominant feature.
*Orbital cellulitis*
- Orbital cellulitis is an **infection of the orbital tissues**, usually presenting with proptosis, ophthalmoplegia, pain, and fever.
- This is an infectious process and would typically take longer than 6 hours to develop to such an extent after an acute trauma without an open wound or obvious contamination.
Scleritis: Posterior Indian Medical PG Question 5: Which of the following conditions is associated with granulomatous uveitis?
- A. Fuchs' heterochromic iridocyclitis
- B. Behcet's disease
- C. Vogt-Koyanagi-Harada's disease (Correct Answer)
- D. Psoriatic arthritis
Scleritis: Posterior Explanation: ***Vogt-Koyanagi-Harada's disease***
- This systemic autoimmune condition characteristically presents with **bilateral, chronic granulomatous panuveitis**.
- Other typical findings include **neurologic symptoms** (meningism, tinnitus) and **dermatologic manifestations** (vitiligo, poliosis, alopecia).
*Fuchs' heterochromic iridocyclitis*
- This condition is typically associated with **non-granulomatous anterior uveitis**.
- Key features include **heterochromia** (different colored irises), diffuse stellate keratic precipitates, and often a cataract.
*Behcet's disease*
- Behcet's disease causes a **non-granulomatous panuveitis**, which is often recurrent and severe.
- It is characterized by **recurrent oral and genital ulcers**, erythema nodosum, and pathergy.
*Psoriatic arthritis*
- Uveitis associated with psoriatic arthritis is usually **acute, unilateral, and non-granulomatous anterior uveitis**.
- It is often seen in conjunction with **psoriatic skin lesions** and arthritis, commonly affecting the peripheral joints.
Scleritis: Posterior Indian Medical PG Question 6: Most reliable sign of posterior scleritis is:
- A. Disc edema
- B. Choroidal folds
- C. Exudative detachment
- D. T-sign on ultrasound (Correct Answer)
Scleritis: Posterior Explanation: ***T-sign on ultrasound***
- The **T-sign** on B-scan ultrasound is considered the most reliable diagnostic sign of **posterior scleritis**.
- It represents accumulation of **fluid in Tenon's capsule** and is highly specific for the condition.
*Disc edema*
- While **disc edema** can be a clinical finding in posterior scleritis due to inflammation, it is not specific and can be caused by various other conditions, such as **optic neuritis** or papilledema.
- It is not as pathognomonic as the T-sign on ultrasound for confirming the diagnosis.
*Choroidal folds*
- **Choroidal folds** can occur in posterior scleritis due to scleral inflammation and thickening, which can indent the choroid.
- However, choroidal folds can also be seen in other conditions like **orbital tumors** or **hypotony**, making them a less specific indicator.
*Exudative detachment*
- An **exudative retinal detachment** can occur in severe cases of posterior scleritis due to inflammation and fluid leakage from the inflamed choroid into the subretinal space.
- This is a serious complication and a sign of advanced disease, but not the earliest or most reliable diagnostic sign for the condition itself, as it can also be seen in other inflammatory or vascular conditions.
Scleritis: Posterior Indian Medical PG Question 7: Most common type of scleritis among the following is
- A. Necrotizing
- B. Granulomatous
- C. Posterior
- D. Non-necrotizing (Correct Answer)
Scleritis: Posterior 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.
Scleritis: Posterior Indian Medical PG Question 8: A patient presents with a nodular swelling near the limbus, which does not blanch with topical vasoconstrictors and recurs after treatment. Based on the image and clinical presentation, what is the most probable diagnosis?
- A. Scleritis with rheumatoid arthritis (Correct Answer)
- B. Episcleritis with rheumatoid arthritis
- C. Pinguecula
- D. Dry eye
Scleritis: Posterior Explanation: ***Scleritis with rheumatoid arthritis***
- The image shows **deep, violaceous conjunctival injection** with surrounding edema and a nodular appearance near the limbus, consistent with **nodular scleritis**. Scleritis is inflammation of the sclera, often characterized by severe pain and association with systemic autoimmune diseases like **rheumatoid arthritis**, which can cause destructive lesions and recurrence.
- The characteristic **deep vessel engorgement that does not blanch with phenylephrine** and the history of recurrence further support scleritis.
*Episcleritis with rheumatoid arthritis*
- Episcleritis presents with a **more superficial, bright red injection** involving the episclera, which generally **blanches with topical phenylephrine** and is less painful than scleritis.
- While episcleritis can be associated with rheumatoid arthritis, the clinical features described (nodular swelling, deep injection) are more typical of scleritis.
*Pinguecula*
- A pinguecula is a **yellowish patch or bump** on the conjunctiva, typically on the nasal side of the eye, that is **not inflamed** unless irritated.
- It consists of **degenerated collagen fibers** and elastic tissue, and does not present with the diffuse, deep vascular injection seen in the image.
*Dry eye*
- Dry eye is characterized by **ocular dryness, irritation, and sometimes a foreign body sensation**, but it typically causes **diffuse conjunctival hyperemia** rather than a localized, nodular, deep inflammation with surrounding edema as shown.
- While dry eye can be associated with autoimmune diseases, its appearance is not consistent with the depicted nodular lesion.
Scleritis: Posterior Indian Medical PG Question 9: Ciliary staphyloma occurs due to all of the following except:
- A. Scleritis
- B. Absolute glaucoma
- C. Episcleritis (Correct Answer)
- D. Perforating injury
Scleritis: Posterior Explanation: ***Episcleritis***
- **Episcleritis** is a benign, self-limiting inflammation of the episclera, which is a superficial layer of connective tissue, and does not lead to **scleral thinning** or ectasia.
- Therefore, it does not cause **ciliary staphyloma**, which is a bulging of the sclera in the ciliary body region.
*Scleritis*
- **Scleritis** is a severe, chronic inflammatory disease affecting the sclera, often leading to **scleral thinning** and weakening.
- This thinning can predispose to the formation of a **ciliary staphyloma**, especially if the inflammation is localized in the ciliary region.
*Absolute glaucoma*
- **Absolute glaucoma** is a severe form of glaucoma characterized by persistently high **intraocular pressure (IOP)**, leading to total vision loss and often significant **scleral thinning** due to chronic pressure.
- The elevated IOP can cause stretching and thinning of the sclera, particularly in weakened areas like the **ciliary body**, resulting in a **ciliary staphyloma**.
*Perforating injury*
- A **perforating injury** to the globe can directly weaken the **scleral wall**, especially if it occurs near the **ciliary body**.
- Subsequent healing with scar tissue, often under intraocular pressure, can lead to ectasia and the formation of a **ciliary staphyloma**.
Scleritis: Posterior Indian Medical PG Question 10: A patient presents with proptosis, restriction of eye movements, and is found to be euthyroid. What is the most likely diagnosis?
- A. Orbital cellulitis
- B. Orbital lymphoma
- C. Orbital pseudotumor (Correct Answer)
- D. Thyroid eye disease
Scleritis: Posterior Explanation: ***Orbital pseudotumor***
- **Orbital pseudotumor** (also known as idiopathic orbital inflammation) presents with **proptosis** and **restriction of eye movements**.
- Typically presents with **acute or subacute onset** of **painful** ophthalmoplegia and proptosis.
- It is a **diagnosis of exclusion** after ruling out other causes of orbital inflammation, including thyroid eye disease, orbital cellulitis, and orbital neoplasms.
- **Euthyroid status** does not exclude this diagnosis, and it is the **most common painful orbital mass** in adults.
*Orbital cellulitis*
- **Orbital cellulitis** presents with **rapid onset** of **painful proptosis**, **chemosis**, **ophthalmoplegia**, and signs of **acute infection** (fever, periorbital erythema, recent sinusitis).
- The absence of infectious signs and acute inflammatory markers makes this less likely.
*Orbital lymphoma*
- **Orbital lymphoma** typically presents with **slowly progressive, painless proptosis** in older patients.
- It is a **chronic, indolent process** and less likely to cause acute, painful restriction of eye movements.
- Usually presents as a palpable mass in the superotemporal orbit.
*Thyroid eye disease*
- **Thyroid eye disease** (Graves' ophthalmopathy) commonly causes **proptosis** and **restricted eye movements** due to extraocular muscle enlargement.
- While **90% of TED patients have hyperthyroidism**, approximately **5% are euthyroid at presentation** (euthyroid Graves' ophthalmopathy).
- However, TED typically has a **subacute to chronic onset**, bilateral involvement, lid retraction, and characteristic imaging findings (muscle belly enlargement sparing tendons).
- The clinical presentation with acute symptoms and euthyroid state makes **orbital pseudotumor more likely** as the initial diagnosis.
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