Infectious Scleritis — MCQs
Unilateral frontal blisters with upper lid edema and conjunctivitis is seen in?
'S-A-F-E program' was initiated for the control of which of the following conditions?
Which fungus is most commonly associated with orbital cellulitis in patients with diabetic ketoacidosis?
Topical antiviral drugs are not indicated in:
Which virus is most commonly associated with disciform keratitis?
A 25-year-old woman presents with a sudden onset of high fever, chills, and rigors. Blood cultures are pending. What is the next appropriate step in her management?
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?
Ciliary staphyloma occurs due to all of the following except:
Most common type of scleritis is
Which of the following conditions is associated with posterior staphyloma?
Infectious Scleritis Indian Medical PG Practice Questions and MCQs
Question 1: 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 2: 'S-A-F-E program' was initiated for the control of which of the following conditions?
- A. Ocular trauma
- B. Onchocerciasis
- C. Refractive error
- D. Trachoma (Correct Answer)
Explanation: ***Trachoma*** - The **S-A-F-E program** is a comprehensive strategy developed by the World Health Organization (WHO) for the elimination of blinding **trachoma**. - **S-A-F-E** stands for **Surgery** for trichiasis, **Antibiotics** for infection, **Facial cleanliness**, and **Environmental improvement**. *Ocular trauma* - While ocular trauma is a significant cause of vision impairment, its control and prevention strategies are distinct from the specific interventions of the SAFE program. - Management of ocular trauma focuses on immediate medical attention, surgical repair, and preventive measures like protective eyewear. *Onchocerciasis* - **Onchocerciasis**, also known as river blindness, is controlled primarily through mass drug administration of **ivermectin**, alongside vector control. - This condition is caused by a parasitic worm (**Onchocerca volvulus**) and is not targeted by the SAFE program. *Refractive error* - **Refractive errors** (e.g., myopia, hyperopia, astigmatism) are corrected with spectacles, contact lenses, or refractive surgery. - They are not infectious diseases and do not require the public health interventions outlined in the SAFE program.
Question 3: Which fungus is most commonly associated with orbital cellulitis in patients with diabetic ketoacidosis?
- A. Candida
- B. Mucor
- C. Rhizopus (Correct Answer)
- D. Aspergillus
Explanation: ***Rhizopus*** - *Rhizopus* is the most common cause of **mucormycosis** (also called zygomycosis), an aggressive fungal infection that frequently affects immunocompromised patients, especially those with **diabetic ketoacidosis (DKA)**. - *Rhizopus arrhizus* (formerly *R. oryzae*) accounts for approximately **70% of all mucormycosis cases**, making it the single most common causative organism. - In DKA, the acidic environment and high glucose levels favor the growth of **Mucorales fungi**, leading to rapid progression from the sinuses to the orbit and brain (rhinoorbital-cerebral mucormycosis). *Candida* - While *Candida* is a common cause of fungal infections, it typically manifests as **candidemia**, **esophagitis**, or **vulvovaginitis**, and is rarely associated with orbital cellulitis in DKA. - *Candida* infections are more likely in patients with indwelling catheters or those on broad-spectrum antibiotics, rather than specifically linked to DKA-induced orbital cellulitis. *Mucor* - The genus *Mucor* is part of the **Mucorales order** and can cause **mucormycosis** with identical clinical presentations to *Rhizopus*. - However, *Mucor* species account for only **10-20% of mucormycosis cases**, making *Rhizopus* the **most commonly** associated genus as asked in the question. - While both are clinically grouped under "mucormycosis," *Rhizopus* is the more specific and statistically correct answer when identifying the most common causative fungus. *Aspergillus* - *Aspergillus* species are common environmental fungi that can cause invasive infections, particularly in immunocompromised patients, leading to conditions like **aspergilloma** or **invasive aspergillosis**. - While *Aspergillus* can cause sinus and orbital infections, it is less commonly associated with the rapid, aggressive form of orbital cellulitis seen in DKA compared to mucormycosis caused by *Rhizopus*.
Question 4: Topical antiviral drugs are not indicated in:
- A. Metaherpetic ulcer (Correct Answer)
- B. Dendritic ulcer
- C. Stromal necrotizing keratitis
- D. All of the options
Explanation: ***Metaherpetic ulcer*** - Metaherpetic ulcers are **neurotrophic ulcers** that develop as a result of chronic epithelial damage and impaired healing after a herpes simplex virus (HSV) infection, but they are not an active viral replication process. - Topical antivirals are ineffective because there is **no replicating virus** to target; management focuses on promoting corneal healing and preventing secondary infections. *Dendritic ulcer* - A dendritic ulcer is a classic sign of **active HSV keratitis** with replicating virus in the epithelial cells. - Topical antiviral drugs (e.g., acyclovir, ganciclovir) are the **first-line treatment** to inhibit viral replication and promote epithelial healing. *Stromal necrotizing keratitis* - This condition involves **inflammation and necrosis** in the corneal stroma, often due to an immune reaction to HSV antigens rather than direct viral invasion. - While topical antivirals may be used to suppress any residual replicating virus, **topical corticosteroids are often necessary** to control the inflammation, and close monitoring is crucial due to the risk of steroid-induced complications. *All of the options* - This option is incorrect because topical antiviral drugs *are* indicated for **dendritic ulcers** and sometimes as adjunctive therapy for **stromal necrotizing keratitis** where active viral replication might be contributing.
Question 5: Which virus is most commonly associated with disciform keratitis?
- A. Rubella Virus
- B. Herpes Simplex Virus (HSV) (Correct Answer)
- C. Human Immunodeficiency Virus (HIV)
- D. Hepatitis B Virus (HBV)
Explanation: ***Herpes Simplex Virus (HSV)*** - **HSV** is the most common cause of **infectious disciform keratitis**, often following a primary ocular HSV infection or reactivation. - Disciform keratitis caused by HSV is a form of **immune-mediated stromal keratitis**, characterized by corneal edema, inflammation, and potential vision loss. *Rubella Virus* - While Rubella can cause ocular manifestations, such as **congenital cataracts** and **glaucoma** in infants, it is not typically associated with disciform keratitis in adults or children. - **Congenital rubella syndrome** is the primary context for ophthalmic issues related to this virus. *Human Immunodeficiency Virus (HIV)* - HIV can lead to various ocular complications, such as **CMV retinitis**, **Kaposi's sarcoma** of the conjunctiva, and **HIV retinopathy**. - However, HIV itself is **not directly linked** to disciform keratitis. *Hepatitis B Virus (HBV)* - HBV infection primarily affects the **liver** and is not commonly associated with direct ocular infections like keratitis. - Ocular manifestations are rare and often nonspecific, mainly related to systemic immune responses rather than direct viral replication in the eye.
Question 6: A 25-year-old woman presents with a sudden onset of high fever, chills, and rigors. Blood cultures are pending. What is the next appropriate step in her management?
- A. Administer broad-spectrum antibiotics (Correct Answer)
- B. Wait for blood culture results
- C. Start antipyretic therapy only
- D. Order a CT scan
Explanation: ***Administer broad-spectrum antibiotics*** - The patient presents with classic signs of **sepsis** (high fever, chills, rigors), which is a medical emergency requiring prompt intervention [2]. - **Early administration of broad-spectrum antibiotics** is crucial to improve outcomes and reduce mortality in suspected sepsis, even before culture results are available [1]. *Wait for blood culture results* - Delaying antibiotic treatment in a patient with suspected sepsis can lead to rapid clinical deterioration and increased mortality [1]. - While blood cultures are essential to guide definitive therapy, initial empiric broad-spectrum antibiotics should not be withheld [3]. *Start antipyretic therapy only* - Antipyretics only address the symptom of fever and do not treat the underlying infection causing the fever and chills. - This approach would leave the potentially life-threatening infection untreated, leading to worsening patient condition. *Order a CT scan* - A CT scan is not the immediate priority in a patient presenting with acute signs of systemic infection and suspected sepsis. - While it may be useful later to identify a source of infection, controlling the infection with antibiotics is the most urgent step.
Question 7: 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.
Question 8: Ciliary staphyloma occurs due to all of the following except:
- A. Scleritis
- B. Absolute glaucoma
- C. Episcleritis (Correct Answer)
- D. Perforating injury
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**.
Question 9: Most common type of scleritis is
- A. Diffuse anterior
- B. Nodular anterior
- C. Anterior (Correct Answer)
- D. 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.
Question 10: Which of the following conditions is associated with posterior staphyloma?
- A. Pathological myopia (Correct Answer)
- B. Uveoscleritis
- C. Pseudocornea
- D. Angle closure glaucoma
Explanation: **Explanation:** **Posterior staphyloma** is a localized bulging of the weak, thinned sclera lined by uveal tissue, occurring posterior to the equator of the eye. 1. **Why Pathological Myopia is correct:** Pathological (high) myopia is the most common cause of posterior staphyloma. Progressive elongation of the anteroposterior axis of the eyeball leads to excessive stretching and thinning of the posterior pole. This results in an ectasia (bulging) of the sclera, typically at the macula or around the optic nerve head. It is a hallmark feature used to differentiate pathological myopia from simple myopia. 2. **Why the other options are incorrect:** * **Uveoscleritis:** While inflammation can weaken the sclera, it more commonly leads to **ciliary or anterior staphyloma** due to the weakening of the sclera in the limbal or ciliary body region. * **Pseudocornea:** This is a clinical feature of a **total corneal staphyloma**, where a perforated cornea is replaced by organized iris tissue and fibrous tissue, not a posterior scleral bulge. * **Angle closure glaucoma:** Chronic or absolute glaucoma is associated with **equatorial staphyloma** (where the sclera is perforated by vortex veins) or ciliary staphyloma, but not typically posterior staphyloma. **High-Yield Pearls for NEET-PG:** * **Types of Staphyloma:** * **Anterior (Corneal):** Due to corneal perforation/sloughing. * **Ciliary:** Occurs in the ciliary zone (2–3 mm behind limbus). Common in absolute glaucoma. * **Equatorial:** Occurs at the equator where vortex veins exit. * **Posterior:** Occurs at the posterior pole. * **Diagnosis:** Posterior staphyloma is best visualized using **B-scan ultrasonography** or optical coherence tomography (OCT). * **Complication:** It is a major risk factor for myopic macular degeneration and retinal detachment.
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