Conjunctivitis: topical therapy and supportive care MCQs With Answer

Conjunctivitis: topical therapy and supportive care MCQs With Answer

This quiz set is designed for M.Pharm students studying Pharmacotherapeutics I (MPP 102T) to deepen understanding of topical treatments and supportive measures used in conjunctivitis. Questions emphasize pharmacology, drug selection, formulations, dosing considerations, contraindications, ocular pharmacokinetics, and practical supportive care for different etiologies (bacterial, viral, allergic, neonatal, and contact-lens related). The questions mix clinical reasoning with formulation and safety knowledge important for pharmacists involved in ophthalmic therapy. Answers are provided to facilitate self-assessment and revision for examinations and clinical practice.

Q1. Which organism is most commonly implicated as a cause of adult acute bacterial conjunctivitis?

• Staphylococcus aureus
• Streptococcus pneumoniae
• Haemophilus influenzae
• Pseudomonas aeruginosa

Correct Answer: Staphylococcus aureus

Q2. Which topical agent is recommended as the standard prophylactic ointment applied to newborns’ eyes immediately after birth to prevent neonatal conjunctivitis?

• Erythromycin ophthalmic ointment applied once
• Topical ciprofloxacin drops three times daily
• Topical moxifloxacin single dose
• Topical prednisolone acetate ointment once

Correct Answer: Erythromycin ophthalmic ointment applied once

Q3. Topical corticosteroids are contraindicated in which form of ocular infection due to risk of worsening and corneal involvement?

• Herpetic epithelial keratitis
• Allergic conjunctivitis
• Bacterial conjunctivitis caused by Staphylococcus
• Seasonal allergic rhinoconjunctivitis

Correct Answer: Herpetic epithelial keratitis

Q4. Which topical antiviral gel is FDA-approved and commonly used for treatment of herpetic epithelial keratitis?

• Ganciclovir 0.15% ophthalmic gel
• Acyclovir 5% ophthalmic solution
• Topical famciclovir drops
• Topical ribavirin ointment

Correct Answer: Ganciclovir 0.15% ophthalmic gel

Q5. What is the principal risk associated with the preservative benzalkonium chloride (BAK) in chronic topical ophthalmic use?

• Corneal epithelial toxicity and tear-film disruption with chronic use
• Systemic hepatotoxicity after single application
• Increased intraocular pressure within minutes
• Immediate hypersensitivity causing anaphylaxis

Correct Answer: Corneal epithelial toxicity and tear-film disruption with chronic use

Q6. For moderate seasonal allergic conjunctivitis which topical therapy provides rapid relief of itching and also stabilizes mast cells?

• Olopatadine ophthalmic solution (dual antihistamine and mast-cell stabilizer)
• Topical prednisolone acetate alone
• Topical ciprofloxacin drops
• Systemic oral antihistamine only

Correct Answer: Olopatadine ophthalmic solution (dual antihistamine and mast-cell stabilizer)

Q7. In a contact lens wearer with suspected Pseudomonas conjunctivitis, the empiric topical antibiotic of choice is generally which agent?

• Topical ciprofloxacin eye drops
• Topical erythromycin ointment
• Topical sulfacetamide solution
• Topical olopatadine drops

Correct Answer: Topical ciprofloxacin eye drops

Q8. Hyperacute bacterial conjunctivitis (often due to Neisseria gonorrhoeae) is characterized clinically by which key feature?

• Profuse purulent discharge and rapid eyelid swelling
• Intermittent watery tearing with mild redness
• Chronic papillary hypertrophy without discharge
• Bilateral itching with stringy mucoid discharge

Correct Answer: Profuse purulent discharge and rapid eyelid swelling

Q9. Which clinical scenario most strongly indicates the need for systemic antibiotic therapy in an ocular infection?

• Concurrent orbital cellulitis with signs of systemic involvement
• Mild unilateral bacterial conjunctivitis responding to topical drops
• Seasonal allergic conjunctivitis with itching
• Viral conjunctivitis caused by adenovirus

Correct Answer: Concurrent orbital cellulitis with signs of systemic involvement

Q10. Topical nonsteroidal anti-inflammatory drugs (NSAIDs) such as ketorolac are used in conjunctivitis primarily to:

• Inhibit cyclooxygenase and reduce prostaglandin-mediated pain and inflammation
• Directly kill gram-negative bacteria on the conjunctiva
• Stabilize mast cells to prevent histamine release
• Act as decongestants to constrict conjunctival vessels

Correct Answer: Inhibit cyclooxygenase and reduce prostaglandin-mediated pain and inflammation

Q11. Compared with eye drop solutions, ophthalmic ointments are preferred when the primary benefit sought is:

• Prolonged contact time and sustained drug exposure at the ocular surface
• Immediate clear vision after application
• Rapid systemic absorption for systemic infections
• Reduced risk of nocturnal blurring of vision

Correct Answer: Prolonged contact time and sustained drug exposure at the ocular surface

Q12. For routine prevention of neonatal conjunctivitis at birth, the recommended timing and frequency of erythromycin ophthalmic ointment application is:

• A single application to each eye shortly after birth
• Twice daily for seven days starting at birth
• Hourly for 24 hours immediately after birth
• Not recommended; systemic antibiotics are required instead

Correct Answer: A single application to each eye shortly after birth

Q13. In chronic severe allergic conjunctivitis to reduce corticosteroid dependence, which topical immunomodulatory agent is commonly used?

• Topical cyclosporine ophthalmic emulsion
• Topical moxifloxacin solution
• Topical phenylephrine drops
• Topical gentamicin ointment

Correct Answer: Topical cyclosporine ophthalmic emulsion

Q14. Which serious systemic adverse effect is classically associated with systemic chloramphenicol and mandates caution despite its topical use?

• Aplastic anemia
• Pulmonary fibrosis
• Nephrolithiasis
• Hyperglycemia

Correct Answer: Aplastic anemia

Q15. The pharmacologic action of topical agents such as olopatadine in allergic conjunctivitis includes which dual mechanism?

• H1 receptor antagonism and inhibition of mast cell degranulation
• Inhibition of bacterial DNA gyrase and topoisomerase IV
• Prostaglandin synthesis stimulation and increased tear production
• Alpha-adrenergic vasoconstriction and muscarinic antagonism

Correct Answer: H1 receptor antagonism and inhibition of mast cell degranulation

Q16. Which formulation strategy is commonly used to enhance corneal penetration of a topically applied drug?

• Designing an ester prodrug that is converted to the active drug in ocular tissues
• Adding hydrophilic polymers exclusively to increase water solubility
• Using large charged molecules to prevent corneal entry
• Eliminating any lipid-soluble moieties to widen the tear film layer

Correct Answer: Designing an ester prodrug that is converted to the active drug in ocular tissues

Q17. Which ophthalmic formulation is generally preferred for overnight administration to increase drug residence time?

• Ointment formulations
• Preserved aqueous drops
• Immediate-release pellets
• Systemic tablets

Correct Answer: Ointment formulations

Q18. Neonatal conjunctivitis caused by Chlamydia trachomatis is best treated with which regimen?

• Oral erythromycin for the neonate (systemic therapy)
• Topical sulfacetamide drops only
• Topical moxifloxacin single application
• No treatment; it resolves spontaneously without therapy

Correct Answer: Oral erythromycin for the neonate (systemic therapy)

Q19. Which clinical circumstance most strongly warrants obtaining conjunctival culture and sensitivity rather than continuing empiric topical therapy?

• Purulent conjunctivitis unresponsive to appropriate topical antibiotics
• Mild viral conjunctivitis with watery discharge resolving in 48 hours
• Seasonal allergic conjunctivitis controlled with antihistamine drops
• Routine neonatal prophylaxis after single erythromycin application

Correct Answer: Purulent conjunctivitis unresponsive to appropriate topical antibiotics

Q20. As supportive care for allergic conjunctivitis, which conservative measures help reduce symptoms and should be recommended?

• Cool compresses and preservative-free artificial tears; avoid rubbing the eyes
• Frequent hot compresses and topical antibiotics prophylactically
• Daily ocular irrigation with 10% povidone-iodine solution
• Immediate initiation of topical corticosteroids for all cases

Correct Answer: Cool compresses and preservative-free artificial tears; avoid rubbing the eyes

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