Benign Tumors of Conjunctiva — MCQs
What condition is suggested by eyelid papules and a hoarse cry in a child?
In which condition is retinal astrocytoma commonly seen?
Which of the following statements about pyogenic granuloma is false?
A patient presents with skin lesions and erosions on the buccal mucosa. The immunofluorescence image is shown. What is the most likely diagnosis?
A 26-year-old male presents to the outpatient department with a discrete thyroid swelling. On neck ultrasound, an isolated cystic swelling of the gland is seen. What is the risk of malignancy associated with this finding?
Which condition is characterized by conjunctival injection, pharyngeal injection, polymorphic rash, and cervical lymphadenopathy?
What is the term for the fusion of the palpebral and bulbar conjunctiva?
NOT a feature of trachoma:
Features of vernal conjunctivitis are:
Which of the following statements about pterygium is false?
Benign Tumors of Conjunctiva Indian Medical PG Practice Questions and MCQs
Question 1: What condition is suggested by eyelid papules and a hoarse cry in a child?
- A. Croup
- B. Lipoid proteinosis (Correct Answer)
- C. Acrodermatitis enteropathica
- D. Congenital syphilis
Explanation: ***Lipoid proteinosis*** - This condition is characterized by **hoarseness from infancy** due to deposition in the vocal cords and characteristic **beaded papules on the eyelids** (moniliform blepharosis). - Also known as **Urbach-Wiethe disease**, it is a rare autosomal recessive disorder resulting from mutations in the **ECM1 gene**, leading to abnormal deposition of hyaline material in various tissues. *Croup* - Croup typically presents with a **barking cough** and **stridor**, often following a viral upper respiratory infection. - It does not cause eyelid papules or chronic hoarseness from infancy, but rather acute respiratory distress. *Acrodermatitis enteropathica* - This is a rare autosomal recessive disorder of **zinc malabsorption**, leading to a classic triad of **dermatitis**, **diarrhea**, and **alopecia**. - It does not involve eyelid papules or hoarseness as primary features. *Congenital syphilis* - Congenital syphilis can cause a wide range of manifestations, including skin rashes, bone abnormalities, and rhinitis ("snuffles"), but eyelid papules and chronic hoarseness are not typical presenting features. - Diagnosis is usually confirmed by serological tests for syphilis.
Question 2: In which condition is retinal astrocytoma commonly seen?
- A. Tuberous sclerosis (Correct Answer)
- B. Sturge weber syndrome
- C. Von Hippel-Lindau syndrome
- D. Neurofibromatosis
Explanation: ***Tuberous sclerosis*** - **Retinal astrocytoma**, also known as **retinal astrocytic hamartoma**, is a common ocular manifestation of **tuberous sclerosis complex (TSC)** [1]. - These lesions can appear as **mulberry-like nodules** or flat, whitish patches on the retina. - Found in approximately **40-50% of patients** with tuberous sclerosis. *Sturge weber syndrome* - Characterized by a **port-wine stain (facial nevus flammeus)**, **leptomeningeal angioma**, and **glaucoma**. - Ocular manifestations include **choroidal hemangiomas** and increased episcleral venous pressure. - Does not typically involve **retinal astrocytomas**. *Von Hippel-Lindau syndrome* - Associated with **retinal capillary hemangioblastomas** (vascular tumors) and various tumors in other organs like the kidneys, pancreas, and brain. - This condition involves **vascular tumors** in the retina, not astrocytic tumors. - Important differential as it also presents with retinal lesions. *Neurofibromatosis* - A neurocutaneous syndrome characterized by **café-au-lait spots**, **neurofibromas**, and **Lisch nodules** (iris hamartomas). - Ocular manifestations include **optic nerve gliomas** and iris hamartomas, but **not retinal astrocytomas**. - NF-1 is the most common neurocutaneous syndrome but has different retinal pathology. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Central Nervous System, pp. 1318-1319.
Question 3: Which of the following statements about pyogenic granuloma is false?
- A. Benign tumor
- B. Bleeding
- C. Bacterial infection (Correct Answer)
- D. Lobular capillary hemangioma
Explanation: ***Bacterial infection*** - Pyogenic granuloma is **not** caused by a bacterial infection; it is a **vascular lesion** that results from trauma or irritation. - The term "pyogenic" may suggest infection, but it actually refers to **pus-producing**, rather than being related to bacteria. *Bleeding* - Pyogenic granulomas are characterized by **easy bleeding** [1], especially when traumatized, due to their highly vascular nature. - They often appear as **red papules** or nodules that can bleed profusely. *Capillary hemangioma* - Pyogenic granulomas are often confused with **capillary hemangiomas**, but they are distinct entities; the former is more reactive. - Both have **vascular features**, but pyogenic granulomas arise typically in response to **injury** [1]. *Benign tumor* - Pyogenic granulomas are classified as **benign tumors** of the skin and mucous membranes. - They do not metastasize but can recur if not removed completely. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of Infancy and Childhood, pp. 524-525.
Question 4: A patient presents with skin lesions and erosions on the buccal mucosa. The immunofluorescence image is shown. What is the most likely diagnosis?
- A. Bullous pemphigoid
- B. Pemphigus vulgaris (Correct Answer)
- C. Linear IgA disease
- D. Dermatitis herpetiformis
Explanation: ***Pemphigus vulgaris*** - The combination of **flaccid blisters/erosions** on the skin and **buccal mucosal lesions** is characteristic of pemphigus vulgaris. The image showing **intercellular IgG deposits** (a "chicken wire" pattern) in the epidermis confirms the diagnosis on immunofluorescence. - Pemphigus vulgaris is an **autoimmune blistering disease** caused by autoantibodies against **desmoglein 1 and 3**, leading to acantholysis (loss of cell adhesion) within the epidermis. *Bullous pemphigoid* - This condition typically presents with **tense bullae** that are less prone to rupture, and **mucosal involvement is rare**. - Immunofluorescence in bullous pemphigoid shows **linear IgG and C3 deposits at the dermoepidermal junction**, not an intercellular epidermal pattern. *Linear IgA disease* - Characterized by **linear IgA deposition along the basement membrane zone** on direct immunofluorescence. - Clinically, it presents with **blisters** that can be variable in appearance, but the pathognomonic immunofluorescence pattern is distinct. *Dermatitis herpetiformis* - Presents with very **pruritic vesicles and papules**, primarily on extensor surfaces, and is strongly associated with **celiac disease**. - Direct immunofluorescence reveals **granular IgA deposits in the dermal papillae**, which is distinct from the intercellular IgG pattern seen here.
Question 5: A 26-year-old male presents to the outpatient department with a discrete thyroid swelling. On neck ultrasound, an isolated cystic swelling of the gland is seen. What is the risk of malignancy associated with this finding?
- A. 48%
- B. 12%
- C. 24%
- D. 3% (Correct Answer)
Explanation: ***3%*** - **Purely cystic thyroid nodules** (as described in this case with "isolated cystic swelling") have a **very low risk of malignancy**, typically **2-3%** or less. - According to **ATA guidelines** and **TIRADS classification**, purely cystic nodules are considered **low suspicion** lesions. - The cystic nature suggests a **benign process** such as a degenerated adenoma, colloid cyst, or simple cyst. - **Fine needle aspiration (FNA)** may still be considered if the nodule is >2 cm or has any suspicious solid components, but is often not required for purely cystic lesions. *48%* - This percentage is **significantly higher** than the actual malignancy risk for a purely cystic thyroid swelling. - Such a **high risk** would typically be associated with **solid nodules** exhibiting highly suspicious ultrasound features such as: - Microcalcifications - Irregular or spiculated margins - Taller-than-wide shape - Marked hypoechogenicity - Extrathyroidal extension *24%* - This percentage represents a **moderate to high risk** of malignancy, which is **not characteristic** of an isolated purely cystic thyroid swelling. - A risk in this range might be seen with: - **Mixed solid-cystic nodules** with predominantly solid components - Solid nodules with **intermediate suspicious features** on ultrasound *12%* - While lower than 24% or 48%, 12% is still **considerably higher** than the generally accepted malignancy risk for purely cystic thyroid nodules. - This risk level could be plausible for: - **Predominantly cystic nodules** with some eccentric solid components - Solid nodules with **mildly suspicious** features on ultrasound
Question 6: Which condition is characterized by conjunctival injection, pharyngeal injection, polymorphic rash, and cervical lymphadenopathy?
- A. Kawasaki syndrome (Correct Answer)
- B. Measles
- C. Scarlet fever
- D. Mumps
Explanation: ***Kawasaki syndrome*** - **Kawasaki syndrome** is characterized by a constellation of symptoms including **conjunctival injection**, **pharyngeal injection**, a **polymorphic rash**, and **cervical lymphadenopathy**, often described as the CRASH and burn criteria (Conjunctivitis, Rash, Adenopathy, Strawberry tongue, Hand/foot changes, and Fever). - It is an acute systemic vasculitis, primarily affecting young children, and without treatment, it can lead to **coronary artery aneurysms**. *Measles* - Measles is characterized by a maculopapular rash that typically starts on the face and spreads downwards (cephalocaudal), along with the presence of **Koplik spots** on the buccal mucosa. - While it presents with conjunctivitis and rash, the rash is not polymorphic in the same way as Kawasaki, and cervical lymphadenopathy is less prominent. *Scarlet fever* - **Scarlet fever** is caused by Group A Streptococcus and presents with pharyngitis, fever, and a characteristic **sandpaper-like erythematous rash** with circumoral pallor. - While it has pharyngeal involvement and rash, it lacks the **conjunctival injection** and **polymorphic nature of the rash** seen in Kawasaki syndrome. The rash is typically fine and blanching. - Cervical lymphadenopathy may be present but the overall constellation differs from Kawasaki. *Mumps* - Mumps is an acute viral infection primarily characterized by the swelling of the **parotid glands** (parotitis), often accompanied by fever, headache, and malaise. - It does not typically present with conjunctival injection, a polymorphic rash, or prominent cervical lymphadenopathy as seen in Kawasaki syndrome.
Question 7: What is the term for the fusion of the palpebral and bulbar conjunctiva?
- A. Trichiasis (inward growth of eyelashes)
- B. Ectropion (outward turning of eyelid)
- C. Symblepharon (Correct Answer)
- D. Tylosis (thickening of skin on palms and soles)
Explanation: ***Symblepharon*** - **Symblepharon** is the term for the adhesion between the **palpebral conjunctiva** (lining the eyelid) and the **bulbar conjunctiva** (covering the eyeball). - This condition can limit eye movement and cause chronic irritation, often resulting from severe conjunctival inflammation or injury. *Trichiasis (inward growth of eyelashes)* - **Trichiasis** refers to the misdirection of eyelashes such that they rub against the cornea or conjunctiva. - It causes irritation, foreign body sensation, and can lead to corneal abrasion, but it does not involve fusion of conjunctival layers. *Ectropion (outward turning of eyelid)* - **Ectropion** is a condition where the lower eyelid turns outward or sags away from the eyeball. - This exposes the conjunctiva, causing dryness, irritation, and epiphora (excessive tearing), but it is not a fusion of conjunctival tissues. *Tylosis (thickening of skin on palms and soles)* - **Tylosis** is a medical term referring to diffuse **hyperkeratosis** or thickening of the skin, typically observed on the palms and soles. - This condition is completely unrelated to the conjunctiva or eye structures.
Question 8: NOT a feature of trachoma:
- A. Entropion
- B. Corneal opacity
- C. Chalazion (Correct Answer)
- D. Herbert's pits
Explanation: ***Chalazion*** - A **chalazion** is a **lipogranulomatous inflammation** of a **meibomian gland** and is not directly caused by *Chlamydia trachomatis* infection, though chronic inflammation could theoretically predispose to it. - While chronic inflammation of the eyelids in trachoma can cause various complications, a chalazion is a distinct condition related to meibomian gland dysfunction and is not a direct, defining feature of trachoma. *Entropion* - **Entropion**, the **inward turning of the eyelid margin**, is a severe late complication of trachoma caused by conjunctival scarring and contraction. - This inward turning leads to **trichiasis** (**misdirected eyelashes**), which abrades the cornea. *Corneal opacity* - **Corneal opacity** is a common and serious consequence of chronic trachoma, resulting from repeated **corneal abrasions** by misdirected eyelashes (trichiasis) and chronic inflammation. - This scarring can lead to **severe vision impairment** and **blindness**. *Herbert's pits* - **Herbert's pits** are characteristic depressions on the **limbus** (corneoscleral junction) formed after the resolution of **limbal follicles** in chronic trachoma. - They are a diagnostic sign of past or present trachomatous infection.
Question 9: Features of vernal conjunctivitis are:
- A. Papillary hypertrophy
- B. Horner-Trantas spots
- C. Shield ulcer
- D. All of the options (Correct Answer)
Explanation: ***All of the options*** - **Vernal conjunctivitis (VKC)** is a severe form of allergic conjunctivitis characterized by chronic inflammation of the conjunctiva, impacting the cornea in advanced stages. - **Shield ulcers**, **Horner-Trantas dots**, and **papillary hypertrophy** are all classic clinical features observed in VKC. *Shield ulcer* - This is a **corneal complication** of severe vernal conjunctivitis, characterized by epithelial defects that can lead to significant pain and vision impairment. - It develops due to corneal abrasion from the giant papillae on the upper tarsal conjunctiva and direct corneal toxicity from inflammatory mediators. *Horner-Trantas spots* - These are **gelatinous aggregations** of epithelial cells and eosinophils that appear as white dots at the limbus, particularly evident at the superior limbus. - They are one of the **pathognomonic signs** of vernal conjunctivitis, indicating significant allergic inflammation. *Papillary hypertrophy* - Characterized by the development of **large, flattened papillae** (often described as "cobblestone" papillae) on the upper tarsal conjunctiva. - This hypertrophy is a result of chronic inflammation and proliferation of mast cells, eosinophils, and lymphocytes in the conjunctival stroma.
Question 10: Which of the following statements about pterygium is false?
- A. Arise from any part of conjunctiva (Correct Answer)
- B. Can cause astigmatism
- C. Surgery is treatment of choice
- D. UV exposure is risk factor
Explanation: ***Arise from any part of conjunctiva*** **(FALSE - Correct Answer)** - This statement is **FALSE** and thus the correct answer. - Pterygium characteristically arises from the **nasal (interpalpebral) bulbar conjunctiva** in 90-95% of cases. - It does NOT arise from "any part" - it has a specific predilection for the medial (nasal) limbus in the palpebral fissure zone. - Temporal pterygium is much less common (~10% of cases). *Can cause astigmatism* **(TRUE)** - This statement is TRUE. - As a pterygium grows across the cornea, it can induce **corneal astigmatism** by altering the curvature of the cornea. - This irregular corneal surface can blur vision, especially as the pterygium progresses towards the central visual axis. *Surgery is treatment of choice* **(TRUE)** - This statement is TRUE. - **Surgical excision** is the primary treatment for pterygium when it is symptomatic, threatens vision, or causes significant cosmetic concerns. - Indications for surgery include: growth towards the visual axis, inducing high astigmatism, significant discomfort, or cosmetic desire. - Adjunctive measures (mitomycin C, conjunctival autograft) help reduce recurrence. *UV exposure is risk factor* **(TRUE)** - This statement is TRUE. - **Ultraviolet (UV) radiation exposure** is a well-established and significant risk factor for the development and progression of pterygium. - This explains its higher prevalence in individuals living in sunny climates (between 37° N and 37° S latitude - "pterygium belt") and those with outdoor occupations.
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