Conjunctivitis

CONJUNCTIVITIS

Q. 1

A 6 year old child who was not taken any vaccination presented with acute membranous conjunctivitis. Which of the following is TRUE about acute membranous conjunctivitis?

 A

Easy to peel

 B

If you peel, bleeding can occur

 C

Diphtheria causes false membrane

 D

Membrane can not be removed

Q. 1

A 6 year old child who was not taken any vaccination presented with acute membranous conjunctivitis. Which of the following is TRUE about acute membranous conjunctivitis?

 A

Easy to peel

 B

If you peel, bleeding can occur

 C

Diphtheria causes false membrane

 D

Membrane can not be removed

Ans. B

Explanation:

Acute membranous conjunctivitis:

  • It is an acute inflammation of the conjunctiva, characterized by formation of a true membrane on the conjunctiva. 
  • The disease is typically caused by Corynebacterium diphtheriae. 
  • This organism produces a violent inflammation of the conjunctiva, associated with deposition of fibrinous exudate on the surface as well as in the substance of the conjunctiva resulting in formation of a thick, grey-yellow membrane. 
  • The membrane is tough and firmly adherent to the conjunctiva, which on removing bleeds and leaves behind a raw area. 
Ref: Ophthalmology By A. K. Khurana, 3rd edition, Page 86.

Q. 2

A 21 year old female presented with mucopurulent discharge from eyes and foreign body sensation diagnosed of having inclusion conjunctivitis. It is caused by:

 A

Chlamydia trachomatis

 B

Chlamydia psittaci

 C

Herpes

 D

Gonorrhoea

Q. 2

A 21 year old female presented with mucopurulent discharge from eyes and foreign body sensation diagnosed of having inclusion conjunctivitis. It is caused by:

 A

Chlamydia trachomatis

 B

Chlamydia psittaci

 C

Herpes

 D

Gonorrhoea

Ans. A

Explanation:

Inclusion conjunctivitis is caused by Chlamydia trachomatis serovars D–K. The primary source of infection is urethritis in males and cervicitis in females. The transmission of infection may occur to eyes either through contaminated fingers or more commonly through water of swimming pools (hence the name swimming pool conjunctivitis).
 
Ref: Comprehensive Ophthalmology by AK Khurana, 4th edition, Page 68.


Q. 3

Which of the following is a significant distinguishing feature of viral conjunctivitis?

 A

Significant eye pain

 B

Globular purulent discharge

 C

Clear discharge

 D

Eye

Q. 3

Which of the following is a significant distinguishing feature of viral conjunctivitis?

 A

Significant eye pain

 B

Globular purulent discharge

 C

Clear discharge

 D

Eye

Ans. C

Explanation:

Significant eye pain or decreased visual acuity is not consistent with the diagnosis of viral conjunctivitis. The hallmark of bacterial conjunctivitis is a continuous globular purulent discharge seen at the lid margins and in the corners of the eye. Viral conjunctivitis typically has a clear discharge with occasional scant mucoid discharge. Both may present with a history of the eye “matted shut” in the morning.

Ref: Levsky M.E., DeFlorio P. (2010). Chapter 2. Ophthalmologic Conditions. In K.J. Knoop, L.B. Stack, A.B. Storrow, R.J. Thurman (Eds), The Atlas of Emergency Medicine, 3e.

Quiz In Between


Q. 4

Which of the following is the MOST COMMON cause of membranous conjunctivitis?

 A

Moraxella

 B

Gonococcus

 C

Staphylococcus

 D

Corynebacterium diphtheriae

Q. 4

Which of the following is the MOST COMMON cause of membranous conjunctivitis?

 A

Moraxella

 B

Gonococcus

 C

Staphylococcus

 D

Corynebacterium diphtheriae

Ans. D

Explanation:

Organism most commonly causing membranous conjunctivitis is Corynebacterium diphtheriae and Streptococcus pyogenes. 
 
Membranes formed by bacteria can be true membrane or pseudo membranes. The true membrane is formed after more severe inflammation and the exudate has a high fiber content and coagulation occurs in the epithelium so that on being stripped the epithelium remain attached to the membrane leaving a raw bleeding surface. In case of pseudomembranes, there is coagulation of exudate on the surface of epithelium and on being stripped there are no underlying bleeding points.
 
Ref: Textbook of Ophthalmology edited by Sunita Agarwal page 885.

Q. 5

Which of the following does not cause hemorrhagic conjunctivitis

 A

Adenovirus

 B

Coxsackie-24

 C

Enterovirus-70

 D

Papilloma virus

Q. 5

Which of the following does not cause hemorrhagic conjunctivitis

 A

Adenovirus

 B

Coxsackie-24

 C

Enterovirus-70

 D

Papilloma virus

Ans. D

Explanation:

D. i.e. Papilloma virus


Q. 6

A recurrent bilateral conjunctivitis occurring with the onset of hot weather in young boys with symptoms of burning, itching, and lacrimation with polygonal raised areas in the palpebral conjunctiva is:

 A

Trachoma

 B

Phlyctenular conjunctivitis

 C

Mucopurulrnt conjunctivitis

 D

Vernal kerato conjunctivitis

Q. 6

A recurrent bilateral conjunctivitis occurring with the onset of hot weather in young boys with symptoms of burning, itching, and lacrimation with polygonal raised areas in the palpebral conjunctiva is:

 A

Trachoma

 B

Phlyctenular conjunctivitis

 C

Mucopurulrnt conjunctivitis

 D

Vernal kerato conjunctivitis

Ans. D

Explanation:

D i.e. Vernal Keratoconjunctivitis

Quiz In Between


Q. 7

Epidemics of conjunctivitis are known to occur with:

 A

Bacterial infections

 B

Viral infections

 C

 

None of the above

 

 D

Both of the above

Q. 7

Epidemics of conjunctivitis are known to occur with:

 A

Bacterial infections

 B

Viral infections

 C

 

None of the above

 

 D

Both of the above

Ans. D

Explanation:

Ans. Both of the above


Q. 8

Most common bacteria associated with conjunctivitis is

 A

Staphylococcus aureus

 B

Streptococcus pneumoniae

 C

Haemophilus influenzae

 D

Neisseria gonorrhoea

Q. 8

Most common bacteria associated with conjunctivitis is

 A

Staphylococcus aureus

 B

Streptococcus pneumoniae

 C

Haemophilus influenzae

 D

Neisseria gonorrhoea

Ans. A

Explanation:

Ans. Staphylococcus aureus


Q. 9

Swimming pool conjunctivitis is caused by

 A

Chlamydia trachomatis

 B

Adenovirus type 8

 C

Adenovirus type 8

 D

Gonococcus

Q. 9

Swimming pool conjunctivitis is caused by

 A

Chlamydia trachomatis

 B

Adenovirus type 8

 C

Adenovirus type 8

 D

Gonococcus

Ans. A

Explanation:

Ans., Chlamydia trachomatis

Quiz In Between


Q. 10

All are true about phlyctenular conjunctivitis except:

 A

It is type-IV cell mediated hypersensitivity

 B

Allergens are endogenous as well as exogenous

 C

Incidence is higher in girls than boys

 D

Nodular lesion usually occurs near the limbus

Q. 10

All are true about phlyctenular conjunctivitis except:

 A

It is type-IV cell mediated hypersensitivity

 B

Allergens are endogenous as well as exogenous

 C

Incidence is higher in girls than boys

 D

Nodular lesion usually occurs near the limbus

Ans. B

Explanation:

Ans. Allergens are endogenous as well as exogenous


Q. 11

Acute haemorrhagic conjunctivitis is seen with:

 A

Adenovirus

 B

Staphylococcus

 C

Pneumococcus

 D

Haemophilus

Q. 11

Acute haemorrhagic conjunctivitis is seen with:

 A

Adenovirus

 B

Staphylococcus

 C

Pneumococcus

 D

Haemophilus

Ans. A

Explanation:

Ans. Adenovirus


Q. 12

Conjunctivitis in newborn is commonly caused by:

 A

Streptococcus

 B

Gonococcus

 C

Pseudomonas

 D

Chlamydia

Q. 12

Conjunctivitis in newborn is commonly caused by:

 A

Streptococcus

 B

Gonococcus

 C

Pseudomonas

 D

Chlamydia

Ans. D

Explanation:

Ans. Chlamydia

Quiz In Between


Q. 13

Ligneous conjunctivitis is caused by:

 A

Purulent conjunctivitis

 B

Membranous conjunctivitis

 C

Angular conjunctivitis

 D

Phlyctenular conjunctivitis

Q. 13

Ligneous conjunctivitis is caused by:

 A

Purulent conjunctivitis

 B

Membranous conjunctivitis

 C

Angular conjunctivitis

 D

Phlyctenular conjunctivitis

Ans. B

Explanation:

Ans. Membranous conjunctivitis


Q. 14

Unilateral chronic conjunctivitis may be associated with

 A

Habit of smoking

 B

Use of uniocular microscope

 C

Foreign body retained is the fornix

 D

Unilateral aphakia

Q. 14

Unilateral chronic conjunctivitis may be associated with

 A

Habit of smoking

 B

Use of uniocular microscope

 C

Foreign body retained is the fornix

 D

Unilateral aphakia

Ans. C

Explanation:

Ans. Foreign body retained is the fornix


Q. 15

Inclusion body conjunctivitis true is all except:

 A

Self limiting

 B

Present only in infants

 C

Occurs while passage from birth canal

 D

Caused by chlamydia

Q. 15

Inclusion body conjunctivitis true is all except:

 A

Self limiting

 B

Present only in infants

 C

Occurs while passage from birth canal

 D

Caused by chlamydia

Ans. B

Explanation:

Ans. Present only in infants

Quiz In Between


Q. 16

Follicular conjunctivitis are found in all except:

 A

Herpes simplex conjunctivitis

 B

Drug induced

 C

Adult inclusion conjunctivitisAllergic conjunctivitis

 D

None

Q. 16

Follicular conjunctivitis are found in all except:

 A

Herpes simplex conjunctivitis

 B

Drug induced

 C

Adult inclusion conjunctivitisAllergic conjunctivitis

 D

None

Ans. D

Explanation:

Ans. None


Q. 17

Neonatal conjunctivitis is caused by all except:

 A

Gonococcus

 B

Chlamydia

 C

Aspergillus

 D

Pseudomonas

Q. 17

Neonatal conjunctivitis is caused by all except:

 A

Gonococcus

 B

Chlamydia

 C

Aspergillus

 D

Pseudomonas

Ans. C

Explanation:

Ans. Aspergillus


Q. 18

Which of the following virus does not cause conjunctivitis:               

March 2010

 A

CMV

 B

Adenovirus

 C

Herpes simplex virus

 D

Picornavirus

Q. 18

Which of the following virus does not cause conjunctivitis:               

March 2010

 A

CMV

 B

Adenovirus

 C

Herpes simplex virus

 D

Picornavirus

Ans. A

Explanation:

Ans. A: CMV

Conjunctivitis can be classified as infectious or noninfectious.

Infectious conjunctivitis (pinkeye) accounts for 70 percent of all cases and is caused by either a bacteria (usually staphylococci, pneumococci, streptococci or chlamydia trachomatis) or a virus.

Bacterial conjunctivitis occurs in 50 percent of all cases, and viral conjunctivitis occurs in 20 percent. Infectious conjunctivitis is very contagious.

Noninfectious conjunctivitis (which accounts for the remaining 30 percent of all cases), can be caused by allergies (such as pollen or grass), chemicals (such as air pollutants, smoke or household cleaners), or underlying diseases (such as rheumatoid arthritis, lupus, Kawasaki’s disease, ulcerative colitis or Crohn’s disease).

Additionally, conjunctivitis can be caused by hemorrhaging from trauma or changes in pressure within the head (subconjunctival hemorrhage).

Viral causes of conjunctivitis:

  • Herpes simplex
  • Adenovirus
  • Picornavirus (Coxsackie virus,enterovirus 70)
  • Myxovirus (measles)
  • Paramyxoviruses (mumps, Newcastle conjunctivitis)
  • Molluscum contagiosum

Quiz In Between


Q. 19

Acute hemorrhagic conjunctivitis is caused by ‑

 A

Enterovirus 70

 B

Adenovirus

 C

Poliovirus

 D

Hepadnavirus

Q. 19

Acute hemorrhagic conjunctivitis is caused by ‑

 A

Enterovirus 70

 B

Adenovirus

 C

Poliovirus

 D

Hepadnavirus

Ans. A

Explanation:

Ans. is ‘a’ i.e., Enterovirus 70

Acute hemorrhagic conjunctivitis (AHC) may be caused by adenoviruses, but two enterovirusesenterovirus 70 and coxsackie A24 variant, are the major causes


Q. 20

True about phlyctenular conjunctivitis are all, except‑

 A

Endogenous allergy

 B

Caused by staphylococcus

 C

Type II hypersensitivity

 D

Usually unilateral

Q. 20

True about phlyctenular conjunctivitis are all, except‑

 A

Endogenous allergy

 B

Caused by staphylococcus

 C

Type II hypersensitivity

 D

Usually unilateral

Ans. C

Explanation:

Ans. is ‘c’ Type II hypersensitivity

Phlyctenular keratoconjunctivitis

  • Phlyctenular conjunctivitis is an allergic response of the conjunctival and corneal epithelium to some endogenous allergens and characterized by formation of the phlyctens. Phlyctens are grey, yellow or pinkish white nodules slightly raised above the surface, are seen on the bulbar conjunctiva, generally near the limbus. Peak age group is 3-15 years with slight female preponderance.

Etiology

  • It is believed to be a delayed hypersensitivity (Type IV cell mediated) response to endogenous microbial proteins. Causative allergens are : – i) Staphylococcus proteins (most common); ii) Tuberculous proteins iii) Proteins of Moraxella axenfeld bacillus and certain parasites.

Symptoms

  • Disease is usually unilateral (in contrast to vernal keratoconjunctivitis which is bilateral). There is mild irritation, discomfort and lacrimation. Itching is not prominent as seen in vernal keratoconjunctivitis.
  • Phlyctens are pinkish white nodules at limbus. Phlyctens are surrounded by hyperamia (congestion) and this congestion of vessels is limited to the area around phlyctens. Phlyctens ulcerate at apex.
  • Corneal involvement may result in miliary ulcer, ring ulcer, fascicular ulcer or sacrofulous ulcer. There may be diffuse infiltrative phlyctenular keratitis.

Treatment

  • Topical steroids are the DOC.

Q. 21

Vernal keratoconjunctivitis is associated with ‑

 A

Corneal opacity

 B

Bacterial ulcer

 C

Spring season

 D

Glaucoma

Q. 21

Vernal keratoconjunctivitis is associated with ‑

 A

Corneal opacity

 B

Bacterial ulcer

 C

Spring season

 D

Glaucoma

Ans. A

Explanation:

Ans. is ‘a’ i.e., Corneal opacity

Vernal kerato conjunctivitis (spring cattarrh)

  • Spring cattarrh is an allergic inflammation of conjunctiva which is characterized by recurrent, bilateral, inter‑stitial, selflimiting conjunctivitis that becomes aggravated during spring and summer period.
  • It is considered to be Type I hypersensitivity reaction (immediate type) to exogenous allergens such as grass pollens.
  • It is more common in boys and affects age group 4-20 years.
  • More common in summer, hence the name spring catarrh looks a misnomer.
  • Recently it is being labeled as “Warm weather conjunctivitis”.

Clinical features of spring catarrh

  • Spring catarrh is characterized by marked itching & burning, Stringy (ropy) discharge, lacrimation, photo-phobia and heaviness of lids.
  • Clinically spring catarrh is divided into three types :
  1. Palpebral form : – It is the most common types. The upper palpebral conjunctiva shows papillae (papillary hypertrophy with their characteristic appearance : – i) Lage & flat toped, ii) Cobble stone appearance (Pavement stone appearance). These papilla heal without scarring.
  2. Bulbar form : – It is characterized by (i) Dusky red triangular congestion of bulbar conjunctiva in palpebral area; ii) Gelatinous thickened accumulation of tissue around the limbus; iii) Presence of discrete whitish raised dots along the limbus (Tranta’s spot).
  3. Mixed form : – Both bulbar and palpebral manifestations occur together.

Corneal signs (Vernal keratopathy)

  • Punctate epithelial keratitis
  • Ulcerative vernal keratitis : shallow transverse ulcer (Shield ulcer)
  • Vernal corneal plaques
  • Subepithelial scarring
  • Pseudogerontoxon: chracterized by a classical “cupid’s bow” outline.

Quiz In Between


Q. 22

Which of the following is not true of acute conjunctivitis?

 A

Vision is not affected

 B

Corneal infiltration

 C

Topical antibiotics are the mainstay of treatment

 D

Pupil remains unaffected

Q. 22

Which of the following is not true of acute conjunctivitis?

 A

Vision is not affected

 B

Corneal infiltration

 C

Topical antibiotics are the mainstay of treatment

 D

Pupil remains unaffected

Ans. C

Explanation:

Ans. c. Topical antibiotics are the mainstay of treatment


Q. 23

Angular conjunctivitis is caused by

 A

Moraxella

 B

Virus

 C

Bacteroides

 D

Fungus

Q. 23

Angular conjunctivitis is caused by

 A

Moraxella

 B

Virus

 C

Bacteroides

 D

Fungus

Ans. A

Explanation:

Ans. is ‘a’ i.e., Moraxella 

Angular conjunctivitis

  • It is a type of chronic conjunctivitis characterized by mild grade inflammation confined to conjunctiva and lid margins near the angles associated with maceration of the surrounding skin.
  • Moraxella axenfeld (Moraxella lacunata), a diplobacillus, is the commonest causative organism. o Less commonly, staphylococcus aureus can also cause angular conjunctivitis.
  • Angular conjunctivitis responds to tetracycline ointment.
  • Eye drops containing zinc inhibit the proteolytic ferment and are of great value although less rapidly effective, and may be used in addition to tetracycline.

Q. 24

Inclusion conjunctivitis is caused by

 A

Trachoma

 B

Pneumococcus

 C

Candida

 D

Neisseria

Q. 24

Inclusion conjunctivitis is caused by

 A

Trachoma

 B

Pneumococcus

 C

Candida

 D

Neisseria

Ans. A

Explanation:

Ans. is ‘a’ i.e., Trachoma 

Adult inclusion conjunctivitis

  • It is a type of follicular conjunctivitis caused by serotypes D to K of chlamydia trachomatis-in sexually active young adults.
  • The primary source of infection is urethritis in males and cervicitis in females.
  • Transmission may occur either through contaminated fingers or through contaminated water of swimming pools (Swimming pool granuloma).
  • Presentation is similar to other acute follicular conjunctivits with mucopurulent discharge. 
  • The disease runs a benign course and often evolves into the chronic follicular conjunctivitis.

Q. 25

Phlyctenular conjunctivitis is caused by –

 A

Chlaymydia

 B

Staphylococcus

 C

Pneumococcus

 D

Aspergillus

Q. 25

Phlyctenular conjunctivitis is caused by –

 A

Chlaymydia

 B

Staphylococcus

 C

Pneumococcus

 D

Aspergillus

Ans. B

Explanation:

Ans. is ‘b’ i.e., Staphylococcus

Phlyctenular keratoconjunctivitis

  • Phlyctenular conjunctivitis is an allergic response of the conjunctival and corneal epithelium to some endogenous allergens and characterized by formation of the phlyctens. Phlyctens are grey, yellow or pinkish white nodules slightly raised above the surface, are seen on the bulbar conjunctiva, generally near the limbus. Peak age group is 3-15 years with slight female preponderance.

Quiz In Between



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