Ocular Immunology — MCQs
Which of the following findings is typically NOT seen in a patient with allergic conjunctivitis?
All the following diseases are associated with HLA B-27 & Uveitis, except -
What is the most common cause of anterior uveitis?
Which of the following is not a component of innate immunity?
Which of the following conditions is associated with granulomatous uveitis?
Dalen-Fuchs nodules are seen in which of the following?
Which of the following is a known complication of vernal keratoconjunctivitis?
Not a feature of ligneous conjunctivitis:
Which of the following indicates activity of anterior uveitis?
What is entropion?
Ocular Immunology Indian Medical PG Practice Questions and MCQs
Question 1: Which of the following findings is typically NOT seen in a patient with allergic conjunctivitis?
- A. Watery discharge
- B. Itching
- C. Bilateral eye redness
- D. Purulent discharge (Correct Answer)
Explanation: ***Purulent discharge*** - **Purulent discharge** (thick, yellowish, or greenish) is characteristic of **bacterial conjunctivitis** and is usually absent in allergic conjunctivitis. - Allergic conjunctivitis typically presents with a **clear or watery discharge**. *Watery discharge* - **Watery discharge** is a very common symptom of **allergic conjunctivitis**, often accompanied by itching and redness. - It results from the inflammatory response and increased lacrimation due to allergen exposure. *Itching* - **Ocular itching** is the hallmark symptom of allergic conjunctivitis and is considered its most distinctive feature. - It is caused by the release of **histamine** and other inflammatory mediators from mast cells in response to allergens. *Bilateral eye redness* - **Bilateral conjunctival redness** (hyperemia) is a frequent finding in allergic conjunctivitis. - This is due to **vasodilation** in response to the inflammatory process affecting both eyes, as airborne allergens often affect both simultaneously.
Question 2: All the following diseases are associated with HLA B-27 & Uveitis, except -
- A. Ankylosing Spondylitis
- B. Psoriasis
- C. Reiter's syndrome
- D. Behçet's syndrome (Correct Answer)
Explanation: **Behçet's syndrome** - **Behçet's syndrome** is an immune-mediated vasculitis characterized by recurrent oral and genital ulcers, skin lesions, and **uveitis**. It is strongly associated with **HLA-B51**, not HLA-B27. - While it can cause uveitis, its genetic association and clinical presentation are distinct from the HLA-B27 spondyloarthropathies. *Ankylosing Spondylitis* - **Ankylosing Spondylitis** is a chronic inflammatory disease primarily affecting the axial skeleton, characterized by sacroiliitis and spondylitis. It is strongly associated with **HLA-B27** and can present with **anterior uveitis** [1]. - Approximately 25-40% of patients with ankylosing spondylitis experience acute anterior uveitis, making it a common extra-articular manifestation. *Psoriasis* - **Psoriasis** is a chronic inflammatory skin condition that can be associated with **psoriatic arthritis**, a spondyloarthropathy [1]. Psoriatic arthritis has a genetic predisposition, with some cases linked to **HLA-B27**, and can manifest with **uveitis**. - The presence of uveitis in a patient with psoriasis and joint pain suggests psoriatic arthritis, a disease known to be associated with HLA-B27 in a subset of patients. *Reiter's syndrome* - **Reiter's syndrome**, now more commonly referred to as **Reactive Arthritis**, is a seronegative spondyloarthropathy that typically develops after a genitourinary or gastrointestinal infection. It is strongly associated with **HLA-B27** [1]. - The classic triad of symptoms includes **arthritis**, **urethritis**, and **conjunctivitis** or **uveitis**, making it a clear association with both HLA-B27 and uveitis [2].
Question 3: What is the most common cause of anterior uveitis?
- A. CMV
- B. Toxoplasma
- C. Idiopathic (Correct Answer)
- D. Ankylosing spondylitis
Explanation: ***Idiopathic*** - In a significant proportion of cases of **anterior uveitis**, a specific cause cannot be identified, leading to a diagnosis of idiopathic uveitis. - This highlights the multifactorial nature of the condition, where various triggers or underlying predispositions may not always be evident. *CMV* - **Cytomegalovirus (CMV)** typically causes a **posterior uveitis** or **retinitis**, especially in immunocompromised individuals. - While CMV can rarely cause anterior uveitis, it is not the most common cause. *Toxoplasma* - **Toxoplasmosis** is a frequent cause of **posterior uveitis** or **chorioretinitis**, characterized by focal necrotic lesions in the retina. - It is not a common cause of isolated anterior uveitis, although anterior chamber inflammation can occur secondary to posterior disease. *Ankylosing spondylitis* - **Ankylosing spondylitis** is a well-known systemic condition associated with **acute anterior uveitis**. - However, while a significant association exists, it is not the single most common cause when considering all cases of anterior uveitis, many of which remain idiopathic.
Question 4: Which of the following is not a component of innate immunity?
- A. Epithelial barriers
- B. NK cells
- C. Dendritic cells
- D. Helper T lymphocytes (Correct Answer)
Explanation: ***Helper T lymphocyte*** - Helper T lymphocytes are a crucial part of **adaptive immunity** [4], facilitating responses against pathogens. - They specifically activate B cells and cytotoxic T cells [2], unlike components of innate immunity, which respond nonspecifically. *NK cells* - Natural Killer (NK) cells are integral to **innate immunity** [1], targeting infected or tumor cells without prior sensitization. - They play a role in the initial response to viral infections and can produce **cytokines** [2]. *Epithelial barriers* - Epithelial barriers act as the first line of defense in **innate immunity** [1], preventing pathogen entry. - They include physical and chemical barriers like skin and mucous membranes [3]. *Dendritic cells* - Dendritic cells are key antigen-presenting cells involved in **innate immunity** [1] and link to adaptive immunity. - They capture and present antigens [2], activating T cells to mount an immune response. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of the Immune System, pp. 194-196. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of the Immune System, pp. 207-208. [3] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. (Basic Pathology) introduces the student to key general principles of pathology, both as a medical science and as a clinical activity with a vital role in patient care. Part 2 (Disease Mechanisms) provides fundamental knowledge about the cellular and molecular processes involved in diseases, providing the rationale for their treatment. Part 3 (Systematic Pathology) deals in detail with specific diseases, with emphasis on the clinically important aspects., pp. 152-153. [4] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of the Immune System, pp. 196-198.
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
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.
Question 6: Dalen-Fuchs nodules are seen in which of the following?
- A. Retinal detachment
- B. Spring catarrh
- C. Sympathetic ophthalmitis (Correct Answer)
- D. Vogt-Koyanagi-Harada disease
Explanation: ***Sympathetic ophthalmitis*** - **Dalen-Fuchs nodules** are characterized by accumulations of **lymphocytes, epithelioid cells, and pigment** in the choroid, specifically between Bruch's membrane and the retinal pigment epithelium. - They are a **pathognomonic sign** of sympathetic ophthalmitis, an autoimmune inflammatory reaction in the contralateral eye after penetrating trauma or surgery to the other eye. - These nodules represent a **granulomatous inflammatory response** and are a key histopathological finding. *Retinal detachment* - This condition involves the **separation of the neurosensory retina** from the underlying retinal pigment epithelium. - It is typically characterized by symptoms such as **flashes of light, floaters**, and a **darkening peripheral visual field**, rather than specific nodular formations in the choroid. *Spring catarrh* - Also known as **vernal keratoconjunctivitis**, this is a severe, chronic, bilateral inflammation of the conjunctiva, primarily affecting children and young adults, often with a history of atopy. - Its characteristic features include **papillae on the upper tarsal conjunctiva** and **Trantas dots** (collections of eosinophils and epithelial cells) at the limbus, not Dalen-Fuchs nodules. *Vogt-Koyanagi-Harada disease* - While VKH disease can also show Dalen-Fuchs nodules as it shares similar granulomatous uveitis features, it is a **distinct bilateral panuveitis** with systemic manifestations including **poliosis, vitiligo, dysacusia, and meningismus**. - The key differentiating factor is that **sympathetic ophthalmitis requires prior trauma or surgery to one eye**, whereas VKH disease has no such requirement and presents with characteristic extraocular manifestations.
Question 7: Which of the following is a known complication of vernal keratoconjunctivitis?
- A. Keratoconus (Correct Answer)
- B. Retinal detachment
- C. Vitreous hemorrhage
- D. Cataract
Explanation: ***Keratoconus*** - **Vernal keratoconjunctivitis (VKC)** is a chronic allergic eye condition associated with persistent eye rubbing, which can lead to thinning and bulging of the cornea, a condition known as **keratoconus**. - Long-term inflammation and mechanical stress from allergic reactions and *eye rubbing* contribute to the corneal structural changes seen in keratoconus. - This is the **most common and well-recognized complication** of VKC. *Cataract* - While cataracts can occur in VKC patients (particularly from **chronic topical steroid use** or severe disease with shield ulcers), they are **less common than keratoconus** as a direct complication. - Keratoconus remains the more characteristic and frequently encountered complication specifically associated with the mechanical trauma of eye rubbing in VKC. *Retinal detachment* - **Retinal detachment** is a condition where the retina separates from its underlying support tissues and is typically associated with trauma, high myopia, or diabetic retinopathy, not VKC. - VKC primarily affects the conjunctiva and cornea, and its inflammatory processes do not directly cause retinal detachment. *Vitreous hemorrhage* - **Vitreous hemorrhage** involves bleeding into the gel-like substance that fills the eye and is commonly caused by conditions like diabetic retinopathy or retinal tears, not VKC. - VKC does not involve the posterior segment of the eye in a way that would lead to vitreous hemorrhage.
Question 8: Not a feature of ligneous conjunctivitis:
- A. Recurrent nature
- B. Wood-like membranes
- C. Bacterial origin (Correct Answer)
- D. Plasminogen deficiency
Explanation: ***Bacterial origin*** - **Ligneous conjunctivitis** is primarily a genetic disorder due to **plasminogen deficiency**, not a bacterial infection. - While secondary bacterial infections can occur, they are not the underlying cause or hallmark feature of this condition. *Recurrent nature* - The disease is characterized by a **recurrent nature**, with pseudomembranes frequently reforming even after surgical removal. - This tendency for recurrence underscores the underlying systemic enzymatic deficiency. *Wood-like membranes* - The hallmark clinical feature of ligneous conjunctivitis is the formation of **dense, rigid, wood-like pseudomembranes** on the conjunctiva, particularly the palpebral conjunctiva. - These membranes are composed of fibrin and other extracellular matrix components, which accumulate due to impaired fibrinolysis. *Plasminogen deficiency* - Ligneous conjunctivitis is caused by a profound deficiency or dysfunction of **plasminogen**, an enzyme crucial for fibrinolysis. - This deficiency leads to impaired breakdown of fibrin, resulting in its abnormal accumulation in various tissues, most notably the eye.
Question 9: Which of the following indicates activity of anterior uveitis?
- A. Cells in anterior chamber (Correct Answer)
- B. Circumcorneal congestion
- C. Keratic precipitate
- D. Corneal edema
Explanation: ***Cells in anterior chamber*** - The presence of **inflammatory cells** (leukocytes) floating in the **aqueous humor** is a direct sign of active inflammation in the anterior uvea. - These cells cause the **Tyndall effect** (flare) when a slit lamp beam is passed through the anterior chamber, indicating active uveitis. *Circumcorneal congestion* - This is a symptom of **uveitis** but doesn't specifically indicate the *activity* of the inflammation. It's a general sign of inflammation in the anterior segment. - It results from dilation of the **perilimbal blood vessels**, which can persist even when the inflammation is subsiding. *Keratic precipitate* - These are **deposits of inflammatory cells** on the posterior corneal surface. While seen in uveitis, they represent the *sequelae* of inflammation rather than active, ongoing cellular activity in the aqueous. - They can be present even in quiescent phases of the disease, making them less indicative of current activity compared to live cells in the anterior chamber. *Corneal edema* - **Corneal edema** can occur in severe anterior uveitis but is not a primary indicator of active inflammation. It usually signifies compromise of the corneal endothelium due to prolonged or severe inflammation. - It is a less direct measure of the ongoing inflammatory process than the presence of cellular activity in the anterior chamber.
Question 10: What is entropion?
- A. Inversion of the eyelid (Correct Answer)
- B. Inversion of the eyelashes
- C. Eversion of the eyelid
- D. Eversion of the eyelashes
Explanation: **Explanation:** **Entropion** is defined as the inward turning (inversion) of the eyelid margin toward the globe. This condition causes the eyelashes and the outer skin of the lid to rub against the cornea and conjunctiva, leading to irritation, corneal abrasions, and potential scarring. It is most commonly seen in the lower eyelid and is frequently associated with aging (involutional entropion), scarring (cicatricial), or muscle spasms (spastic). **Analysis of Options:** * **Option A (Correct):** Entropion specifically refers to the **inversion of the eyelid margin**. The underlying pathophysiology often involves laxity of the medial/lateral palpebral ligaments and overriding of the preseptal orbicularis oculi muscle. * **Option B:** Inversion of the eyelashes is termed **Trichiasis**. While entropion *results* in the lashes touching the eye, trichiasis refers to the misdirection of lashes toward the globe with a normally positioned lid margin. * **Option C:** Eversion (outward turning) of the eyelid margin is called **Ectropion**. This leads to exposure of the palpebral conjunctiva and epiphora (overflow of tears). * **Option D:** Eversion of the eyelashes is not a standard clinical term, though lashes may appear everted in conditions like Distichiasis (an extra row of lashes). **NEET-PG High-Yield Pearls:** * **Involutional Entropion:** The most common type; caused by the overriding of the **orbicularis oculi** over the tarsal plate. * **Cicatricial Entropion:** Often follows Trachoma (the leading infectious cause of blindness) due to scarring of the palpebral conjunctiva. * **Surgical Management:** Common procedures include the **Jones procedure** (for involutional) or the **Wies procedure** (transverse lid rotating suture). * **Complication:** If left untreated, the chronic mechanical trauma can lead to **corneal vascularization and opacification**.
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