Episcleritis — MCQs
Which among the following is the drug of choice for iridocyclitis?
Which type of dermatitis is evaluated through patch testing?
Which of the following is NOT a connective tissue disorder?
In a patient with acute anterior uveitis presenting with raised intraocular pressure, the PRIMARY treatment should be:
As per ISO, color of N2O cylinder is –
All of the following are false about eye lid signs in GRAVES DISEASE except?
A head injured patient, who opens eyes to painful stimulus, is confused and localizes to pain. What is the Glasgow coma score?
What is the most likely diagnosis for a young patient presenting with iritis and joint pain?
Acute orchitis is characterized by all of the following except:
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?
Episcleritis Indian Medical PG Practice Questions and MCQs
Question 1: Which among the following is the drug of choice for iridocyclitis?
- A. Corticosteroids (anti-inflammatory) (Correct Answer)
- B. Pilocarpine (miotic agent)
- C. Atropine (mydriatic agent)
- D. Timolol (beta-blocker)
Explanation: ***Corticosteroids (anti-inflammatory)*** - **Corticosteroids** are the drug of choice for iridocyclitis as they effectively suppress the **inflammation** within the iris and ciliary body. - They work by reducing the influx of inflammatory cells and inhibiting the production of inflammatory mediators, thereby alleviating pain, redness, and preventing complications like **posterior synechiae**. *Atropine (mydriatic agent)* - **Atropine** is a **mydriatic** (pupil-dilating) and cycloplegic agent used in iridocyclitis, but it is not the primary anti-inflammatory treatment. - Its role is to prevent the formation of **posterior synechiae** (adhesions between the iris and lens) and to relieve ciliary spasm, which reduces pain. *Pilocarpine (miotic agent)* - **Pilocarpine** is a **miotic** agent, meaning it constricts the pupil. - Pupil constriction is contraindicated in iridocyclitis as it can worsen pain and promote the formation of **posterior synechiae**. *Timolol (beta-blocker)* - **Timolol** is a **beta-blocker** primarily used to lower intraocular pressure in conditions like glaucoma. - While glaucoma can sometimes be a complication of severe iridocyclitis, timolol does not address the underlying **inflammation** of the iris and ciliary body, which is the primary pathology.
Question 2: Which type of dermatitis is evaluated through patch testing?
- A. Atopic dermatitis
- B. Irritant contact dermatitis
- C. Discoid eczema
- D. Contact dermatitis due to allergens (Correct Answer)
Explanation: ***Contact dermatitis due to allergens*** - **Patch testing** is specifically used to identify specific **allergens** that trigger an **allergic contact dermatitis** reaction. - It involves applying suspected allergens to the skin and observing for a localized inflammatory response, indicating delayed type IV hypersensitivity. *Atopic dermatitis* - This is a chronic inflammatory skin condition characterized by **eczematous lesions** and severe **pruritus**, often linked to a genetic predisposition and immune dysfunction. - While allergy testing (e.g., prick tests, blood tests for IgE) might be used to identify triggers, **patch testing** is not the primary diagnostic tool for atopic dermatitis itself. *Irritant contact dermatitis* - This type of dermatitis is caused by direct **damage to the skin barrier** from exposure to caustic substances or irritants, not an immune-mediated allergic reaction. - Diagnosis is usually based on clinical history of exposure and symptom presentation, and **patch testing** is typically negative in these cases. *Discoid eczema* - Also known as **nummular dermatitis**, this condition presents with distinctive **coin-shaped lesions** and is often associated with dry skin or skin trauma. - Its etiology is generally unknown and not attributable to specific allergens detectable by **patch testing**.
Question 3: Which of the following is NOT a connective tissue disorder?
- A. Osteoarthritis
- B. Fibromyalgia
- C. Sjogren's syndrome (Correct Answer)
- D. SLE
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].
Question 4: 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 5: As per ISO, color of N2O cylinder is –
- A. Black
- B. Blue (Correct Answer)
- C. White
- D. Red
Explanation: ***Blue*** - According to **ISO standards**, the medical gas cylinder for **Nitrous Oxide (N2O)** is uniformly identified by a **blue body**. - This color coding helps in immediate visual recognition to ensure the correct gas is used in medical settings, preventing administration errors. *Black* - A **black cylinder** typically indicates **Nitrogen (N2)** according to ISO standards for medical gases. - Using a black cylinder for nitrous oxide would be a severe error, leading to the administration of the wrong gas. *White* - A **white cylinder** is commonly used for **Oxygen (O2)** as per ISO conventions for medical gas cylinders. - Administering oxygen instead of nitrous oxide would, while not directly harmful, prevent the intended anesthetic or analgesic effect. *Red* - A **red cylinder** is generally used for **Medical Air** in some regions, though it can vary based on local regulations. - In many settings, red can also denote **flammable gases** or **fire-fighting equipment**, making it unsuitable for nitrous oxide.
Question 6: All of the following are false about eye lid signs in GRAVES DISEASE except?
- A. Stellwag's sign: Incomplete and infrequent blinking (Correct Answer)
- B. Mobius sign: convergence insufficiency
- C. Dalrymple sign: lid retraction
- D. Von Graefe's sign: lid lag on downgaze
Explanation: **⚠️ QUESTION ISSUE: All four options are TRUE statements about Graves' disease, making this question technically flawed.** ***Stellwag's sign: Incomplete and infrequent blinking*** ✓ - **Stellwag's sign** is correctly defined as **incomplete and infrequent blinking**, causing a characteristic staring appearance. - This is a **TRUE** sign of **Graves' ophthalmopathy** due to sympathetic overactivity. - **Marked as correct answer**, but all options are actually true. *Mobius sign: convergence insufficiency* ✓ - **Moebius sign** is correctly defined as **convergence insufficiency** (inability to converge eyes for near vision). - This is a **TRUE** sign of **Graves' disease**. - Statement is medically accurate. *Dalrymple sign: lid retraction* ✓ - **Dalrymple's sign** is correctly defined as **lid retraction** (upper eyelid retraction exposing sclera above iris). - This is a **TRUE** and classic sign of **Graves' ophthalmopathy**. - Statement is medically accurate. *Von Graefe's sign: lid lag on downgaze* ✓ - **Von Graefe's sign** is correctly defined as **lid lag on downgaze** (upper eyelid lags behind eyeball during downward gaze). - This is a **TRUE** sign of **Graves' disease**. - Statement is medically accurate. **Educational Note:** This FMGE-2017 question is problematic because all four eyelid sign descriptions are medically accurate. In the actual exam, Stellwag's sign was likely considered the "best" answer, possibly because it's the most specific or commonly tested.
Question 7: A head injured patient, who opens eyes to painful stimulus, is confused and localizes to pain. What is the Glasgow coma score?
- A. 9
- B. 11 (Correct Answer)
- C. 7
- D. 13
Explanation: ***11*** - The Glasgow Coma Scale (GCS) comprises three components: **Eye opening**, Verbal response, and Motor response. - In this case, **eyes opening to pain** scores 2, **confused verbal response** scores 4, and **localizing to pain** scores 5, totaling 2 + 4 + 5 = 11. *9* - A score of 9 would correspond to a lower response in one or more categories, such as **abnormal flexion (decorticate)** as a motor response (3 points) or incomprehensible sounds as verbal response (2 points). - This option does not match the patient's described responses for eye opening (2), verbal (4), and motor (5) components. *7* - A score of 7 indicates a more severe neurological impairment, for instance, no eye opening (1), incomprehensible sounds (2), and **abnormal extension (decerebrate)** as a motor response (2 points). - This GCS score is much lower than what would be calculated from the patient's described responses. *13* - A score of 13 would indicate better neurological function, potentially with spontaneous eye opening (4) or responding with an oriented verbal response (5). - This score suggests less severe injury than the patient's responses of eyes opening to pain (2) and confused verbal response (4).
Question 8: What is the most likely diagnosis for a young patient presenting with iritis and joint pain?
- A. Gout
- B. RA
- C. AS (Correct Answer)
- D. Toxoplasma
Explanation: ***AS (Ankylosing Spondylitis)*** - **Iritis** (anterior uveitis) is a common extra-articular manifestation of **ankylosing spondylitis**, affecting up to 40% of patients [1]. - **Joint pain**, particularly in the axial skeleton (spine and sacroiliac joints), is a hallmark feature in young patients with AS [1]. *Gout* - Characterized by **recurrent attacks of acute inflammatory arthritis** due to **monosodium urate crystal deposition**. - While it causes severe joint pain, **iritis is not a typical manifestation** of gout. *RA (Rheumatoid Arthritis)* - RA is a **chronic autoimmune inflammatory disease** primarily affecting the **synovial joints** symmetrically, mostly in older adults. - While ocular manifestations like **scleritis** or **episcleritis** can occur, **iritis is less common** compared to AS. *Toxoplasma* - **Toxoplasmosis** primarily causes **chorioretinitis** (inflammation of the choroid and retina), not typically isolated iritis. - Although it can cause **arthralgia** (joint pain), it does not cause inflammatory arthritis like the spondyloarthropathies.
Question 9: Acute orchitis is characterized by all of the following except:
- A. Increased local temperature
- B. Erythematous scrotum
- C. Decreased blood flow (Correct Answer)
- D. Raised TLC
Explanation: ***Decreased blood flow*** - **Acute orchitis** is an inflammatory process that typically leads to increased blood flow (hyperemia) to the affected testis due to the inflammatory response. - Decreased blood flow would be more characteristic of conditions like **testicular torsion**, which is an emergent condition causing ischemia. *Increased local temperature* - **Inflammation** is characterized by the classic signs of rubor (redness) and calor (heat), leading to an **increased local temperature** in the affected area. - This is a common finding in acute orchitis due to the inflammatory response. *Erythematous scrotum* - The inflammatory process in orchitis causes **vasodilation** and increased vascular permeability, leading to redness and swelling of the overlying scrotal skin. - An **erythematous scrotum** is a typical clinical sign of acute orchitis. *Raised TLC* - **TLC (Total Leukocyte Count)** is often elevated in cases of acute infection or inflammation, such as orchitis. - A **raised TLC** indicates a systemic inflammatory response to the infection.
Question 10: 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
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.
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