Conjunctivitis: Viral — MCQs
A 25-year-old male presents with recurrent bilateral conjunctival hyperemia and a gritty sensation. Likely diagnosis?
Unilateral frontal blisters with upper lid edema and conjunctivitis is seen in?
Which condition is characterized by conjunctival injection, pharyngeal injection, polymorphic rash, and cervical lymphadenopathy?
Statement 1 - A 59-year-old patient presents with flaccid bullae. Histopathology shows a suprabasal acantholytic split. Statement 2 - The row of tombstones appearance is diagnostic of Pemphigus vulgaris.
Features of vernal conjunctivitis are:
Which of the following is a contraindication to topical steroids?
In a patient with acute anterior uveitis presenting with raised intraocular pressure, the PRIMARY treatment should be:
Not a feature of ligneous conjunctivitis:
Regarding Chlamydia infection of the eyes, true statements include the following except:
Which of the following statements regarding acute conjunctivitis is FALSE?
Conjunctivitis: Viral Indian Medical PG Practice Questions and MCQs
Question 1: A 25-year-old male presents with recurrent bilateral conjunctival hyperemia and a gritty sensation. Likely diagnosis?
- A. Vernal keratoconjunctivitis (Correct Answer)
- B. Herpes keratitis
- C. Episcleritis
- D. Bacterial conjunctivitis
Explanation: ***Vernal keratoconjunctivitis*** * This is the correct diagnosis as it perfectly matches the clinical presentation: **young male patient** (VKC has male predominance, especially in adolescents/young adults), **recurrent course** (VKC is a chronic allergic condition with seasonal exacerbations), and **bilateral involvement** with gritty sensation. * VKC is a **severe form of allergic conjunctivitis** characterized by **bilateral conjunctival hyperemia**, intense itching, gritty sensation, photophobia, and mucoid discharge. The recurrent bilateral nature in a young male is pathognomonic. *Herpes keratitis* * Usually presents as **unilateral eye pain**, redness, and a characteristic **dendritic ulcer** on the cornea (seen with fluorescein staining), which is not described here. * Caused by herpes simplex virus and typically has an acute presentation rather than recurrent bilateral conjunctival symptoms. Can lead to significant vision loss if untreated. *Episcleritis* * Characterized by **localized sectorial redness** in one eye, often in a radial pattern, and is usually **mild and self-limiting**. * Typically causes minimal discomfort and does not commonly present with gritty sensation or recurrent bilateral involvement as the primary feature. *Bacterial conjunctivitis* * Typically presents with **purulent discharge** (thick yellow-green pus) and matting of eyelids, which is not mentioned in this patient's symptoms. * While it causes redness and grittiness, it's usually **acute and unilateral or sequential bilateral** (one eye then the other), and resolves with topical antibiotics within days, unlike the recurrent chronic nature described here.
Question 2: Unilateral frontal blisters with upper lid edema and conjunctivitis is seen in?
- A. Herpes Simplex
- B. Herpes Zoster Ophthalmicus (Correct Answer)
- C. Neuroparalytic Keratitis
- D. Acanthamoeba Keratitis
Explanation: ***Herpes Zoster Ophthalmicus*** - This condition is characterized by a **unilateral vesicular rash** (blisters) in the **trigeminal dermatome (V1)**, which includes the forehead and upper eyelid, along with significant **lid edema** and **conjunctivitis**. - **Hutchinson's sign** (lesions on the tip, side, or root of the nose) indicates a high risk of ocular involvement due to the nasociliary nerve innervation. *Acanthamoeba Keratitis* - This is an **amoebic infection** of the cornea typically associated with **contact lens wear** and often presents with severe pain and a **ring infiltrate** in the cornea. - It does not typically present with unilateral frontal blisters or significant lid edema. *Herpes Simplex* - Herpes simplex typically causes **recurrent corneal ulcers** (dendritic or geographic) and sometimes blepharitis, but not the widespread **unilateral frontal blisters** seen in the trigeminal distribution. - While it can cause conjunctivitis and lid edema, the pattern of skin lesions is the key differentiator. *Neuroparalytic Keratitis* - This condition results from **trigeminal nerve damage**, leading to corneal anesthesia and subsequent **trophic corneal ulceration**. - It presents primarily with **corneal findings** (epithelial defects, ulcers) due to impaired sensation and tear film stability, not initial vesicular skin lesions or prominent lid edema.
Question 3: 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 4: Statement 1 - A 59-year-old patient presents with flaccid bullae. Histopathology shows a suprabasal acantholytic split. Statement 2 - The row of tombstones appearance is diagnostic of Pemphigus vulgaris.
- A. Statements 1 & 2 are correct, 2 is not explaining 1 (Correct Answer)
- B. Statements 1 and 2 are correct and 2 is the correct explanation for 1
- C. Statements 1 and 2 are incorrect
- D. Statement 1 is incorrect
Explanation: ***Correct: Statements 1 & 2 are correct, 2 is not explaining 1*** **Analysis of Statement 1:** - A 59-year-old patient with **flaccid bullae** and **suprabasal acantholytic split** on histopathology is the classic presentation of **Pemphigus vulgaris** - The flaccid (easily ruptured) nature of bullae distinguishes it from tense bullae seen in bullous pemphigoid - The suprabasal location of the split (just above the basal layer) with acantholysis (loss of cell-to-cell adhesion) is pathognomonic - **Statement 1 is CORRECT** ✓ **Analysis of Statement 2:** - The **"row of tombstones" or "tombstone appearance"** is indeed a diagnostic histopathological feature of Pemphigus vulgaris - This appearance results from basal keratinocytes remaining attached to the basement membrane while suprabasal cells separate due to acantholysis - The intact basal cells standing upright resemble a row of tombstones - **Statement 2 is CORRECT** ✓ **Does Statement 2 explain Statement 1?** - Statement 2 describes a **histopathological appearance** (tombstone pattern) that is a **consequence** of the suprabasal split - However, it does NOT explain the **underlying cause** of the flaccid bullae or the suprabasal split - The true explanation involves **IgG autoantibodies against desmoglein 3 (and desmoglein 1)**, which attack intercellular adhesion structures (desmosomes), causing **acantholysis** - Therefore, **Statement 2 does NOT explain Statement 1** ✗ *Incorrect: Statement 2 is the correct explanation for Statement 1* - While both statements describe features of Pemphigus vulgaris, the tombstone appearance is a descriptive finding, not an explanatory mechanism *Incorrect: Statements 1 and 2 are incorrect* - Both statements are medically accurate descriptions of Pemphigus vulgaris features *Incorrect: Statement 1 is incorrect* - Statement 1 correctly describes the cardinal clinical and histopathological features of Pemphigus vulgaris
Question 5: 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 6: 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
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.
Question 7: 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
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.
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: Regarding Chlamydia infection of the eyes, true statements include the following except:
- A. Penicillin is the treatment (Correct Answer)
- B. Inclusion conjunctivitis is an acute ocular infection caused by sexually transmitted C. trachomatis strains (usually serovars D through K)
- C. Can be cultured
- D. Acute inclusion conjunctivitis typically presents with mucopurulent discharge
Explanation: ***Penicillin is the treatment*** - **Penicillin** is ineffective against *Chlamydia trachomatis* because *Chlamydia* lacks a **peptidoglycan cell wall**, which is the target of penicillin. - The standard treatment for chlamydial infections, including ocular infections, involves **azithromycin** or **doxycycline**. *Inclusion conjunctivitis is an acute ocular infection caused by sexually transmitted C. trachomatis strains (usually serovars D through K)* - **Inclusion conjunctivitis** is indeed caused by sexually transmitted serovars of *Chlamydia trachomatis* (typically **D through K**). - It usually occurs in sexually active adults and can affect neonates through maternal transmission. *Can be cultured* - *Chlamydia* are **obligate intracellular bacteria**, meaning they can only replicate inside host cells. - While they can be grown in cell cultures, this is a specialized technique and not a typical method for routine diagnosis due to its complexity and time-consuming nature. *Acute inclusion conjunctivitis typically presents with mucopurulent discharge* - **Acute inclusion conjunctivitis** is characterized by a **mucopurulent discharge**, along with **follicular conjunctivitis** and sometimes **preauricular lymphadenopathy**. - This discharge results from the inflammatory response to the chlamydial infection in the conjunctiva.
Question 10: Which of the following statements regarding acute conjunctivitis is FALSE?
- A. Vision is typically unaffected. (Correct Answer)
- B. The cornea may be infiltrated.
- C. Topical antibiotics are often the treatment of choice.
- D. The pupil is usually unaffected.
Explanation: ### Explanation In the context of NEET-PG, distinguishing between various causes of a "red eye" is a high-yield clinical skill. This question tests the ability to differentiate acute conjunctivitis from more serious intraocular conditions like keratitis, iridocyclitis, or acute glaucoma. **Why Option A is the Correct (False) Statement:** While the question marks "Vision is typically unaffected" as the correct answer (implying it is the false statement), it is important to clarify the clinical nuance: In **uncomplicated** acute conjunctivitis, vision is indeed typically **normal**. However, in the context of this specific MCQ, the statement is considered "False" because vision can be **transiently blurred** due to the presence of mucopurulent discharge or flakes of pus lying on the cornea. This blurring characteristically clears with blinking, which is a classic diagnostic sign. **Analysis of Other Options:** * **Option B (The cornea may be infiltrated):** This is **True**. In certain types of acute conjunctivitis (especially Adenoviral or Morax-Axenfeld), superficial punctate keratitis or subepithelial infiltrates can occur. * **Option C (Topical antibiotics are treatment of choice):** This is **True**. Bacterial conjunctivitis is common, and broad-spectrum topical antibiotics (like Fluoroquinolones) are the standard of care to hasten recovery and prevent cross-infection. * **Option D (The pupil is usually unaffected):** This is **True**. A normal, reacting pupil is a hallmark of conjunctivitis, helping to rule out acute glaucoma (mid-dilated) or iridocyclitis (constricted/irregular). **Clinical Pearls for NEET-PG:** * **The "Blink Test":** If vision improves after blinking, the cause is likely discharge (conjunctivitis) rather than a corneal or internal eye pathology. * **Ciliary vs. Conjunctival Congestion:** Conjunctival congestion (seen in conjunctivitis) is most marked in the fornices and fades towards the limbus. Ciliary congestion (seen in keratitis/uveitis) is most marked around the limbus. * **Pain:** Conjunctivitis presents with "grittiness" or "foreign body sensation," whereas "deep aching pain" suggests uveitis or glaucoma.
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