A patient presents with redness, discharge, and itching in both eyes. The nurse suspects conjunctivitis. Which type of conjunctivitis is most likely based on these symptoms?

1. A

   Viral conjunctivitis

2. B

   Allergic conjunctivitis

3. C

   Bacterial conjunctivitis

4. D

   Chronic conjunctivitis

Appeared in: NORCET 7 Prelims -2024

Explanation

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• The most definitive symptom presented in the question is itching (pruritus).
• Extreme itching is the hallmark sign of allergic conjunctivitis, which is a hypersensitivity reaction to an allergen.
• Other common signs of allergic conjunctivitis include bilateral involvement, redness, excessive tearing (epiphora), and a watery or string-like mucoid discharge.

Why Other Options Were Wrong

• Option A: Viral conjunctivitis is primarily characterized by a watery discharge, a gritty or foreign body sensation, and significant tearing. While mild itching can occur, it is not the predominant symptom.
• Option C: Bacterial conjunctivitis is distinguished by a thick, purulent (pus-like) or mucopurulent discharge that often causes the eyelids to be stuck together upon waking. Itching is minimal or absent.
• Option D: Chronic conjunctivitis describes the duration of the inflammation (typically lasting more than four weeks) rather than the underlying cause. The question describes an acute presentation of symptoms, making this a less specific and therefore incorrect choice.

Related Visual

Clinical Relevance

• Nursing practice connection: Use the key finding related to Differentiating between the common types of conjunctivitis based on clinical signs and symptoms to guide bedside assessment, documentation, and the next nursing action.
• Correctly identifying the type of conjunctivitis is crucial for guiding treatment. Allergic conjunctivitis is managed with antihistamines and allergen avoidance, bacterial conjunctivitis requires antibiotics, and viral conjunctivitis is managed with supportive care as it is self-limiting.
• Patient education is a key nursing role. For viral conjunctivitis, the focus is on hygiene to prevent transmission. For allergic, it's about allergen avoidance. For bacterial, it's about completing the antibiotic course.
• What if? If the patient had reported a thick, yellow-green discharge and their eyelids were 'glued shut' in the morning, the most likely diagnosis would shift to Bacterial conjunctivitis.

How to Approach the Question

• First, identify the patient's main problem: inflamed, irritated eyes, diagnosed as conjunctivitis.
• Next, list the specific signs and symptoms provided in the stem: redness, discharge, and itching in both eyes.
• Analyze the options, which are different etiologies of conjunctivitis.
• Focus on the most distinguishing symptom. While redness and discharge are common to all types, the nature of these symptoms, and especially the presence of itching, are key differentiators.
• Recall or deduce the hallmark symptoms for each type. Intense itching is uniquely characteristic of allergic reactions.
• Match the patient's hallmark symptom (itching) to the corresponding type of conjunctivitis (Allergic) to select the correct answer.

Concept Tested & Keywords

• Concept Tested: Differentiating between the common types of conjunctivitis based on clinical signs and symptoms.
• Stem keywords: conjunctivitis, redness, discharge, itching, both eyes
• Lead-in keywords: most likely
• Clinical cues: The symptom 'itching' is the primary clue to differentiate the types of conjunctivitis.
• Clinical cues: The involvement of 'both eyes' is common in allergic and viral conjunctivitis.

Question ID

QDKSYEKr4wBa-_uamzp-Cr

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Reference Book

E6 Nursing Brunner Adult Health 3SA Vol 2 Part 1 p. 111-113

E6 Medicine Harrison 22e Part 1 p. 265-267