Exophthalmos is a characteristic sign of which disease?

Appeared in: Bihar CHO - 2021

Explanation

Exophthalmos, or the protrusion of eyeballs, is a hallmark sign of hyperthyroidism.
It is most commonly associated with Graves' disease, an autoimmune disorder where antibodies stimulate the thyroid gland.
The underlying cause is the inflammation and swelling of the retro-orbital tissues (muscles and fat behind the eye), which pushes the eyeball forward.
This condition is a direct result of the autoimmune process, not just the high levels of thyroid hormones.

Option A: Hyperpituitarism, specifically when it causes acromegaly due to excess growth hormone, leads to coarse facial features, an enlarged jaw, and prominent brow, but not exophthalmos.
Option C: Increased intracranial pressure (ICP) causes papilledema, which is swelling of the optic disc visible on an ophthalmoscopic exam. It does not cause the eyeball itself to protrude.
Option D: Hypothyroidism is characterized by decreased thyroid hormone levels. Its classic facial sign is myxedema, which includes periorbital puffiness (swelling around the eyes), a dull, puffy face, and dry skin, not protrusion of the eyeballs.

Clinical Relevance

Nursing practice connection: Knowing Clinical manifestations of endocrine disorders helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
Recognizing exophthalmos is crucial for nurses as it is a key diagnostic clue for Graves' disease, prompting further investigation of thyroid function.
Nursing care for patients with exophthalmos focuses on protecting the cornea from drying and injury, managing symptoms, and providing emotional support due to changes in appearance.
What if? If a patient with known hyperthyroidism presents with sudden worsening of eye pain, redness, and vision changes, the nurse must suspect malignant exophthalmos or corneal ulceration, which is a medical emergency requiring immediate ophthalmologic consultation.

How to Approach the Question

First, identify the key term in the question stem: 'Exophthalmos'.
Recall the definition of exophthalmos: the protrusion or bulging of the eyeballs.
Systematically review the options and associate each condition with its classic signs.
Hyperpituitarism is linked to acromegaly (coarse features).
Increased ICP is linked to papilledema (swollen optic disc).
Hypothyroidism is linked to myxedema (facial puffiness).

Concept Tested & Keywords

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E6 Physiology Essentials Sembulingam 10e Part 2 p. 44-46

E6 Nursing Brunner Adult Health 3SA Vol 1 Part 4 p. 20-22

Practise the full Bihar CHO - 2021

Attempt every question from this paper in a timed mock, then review the full solution for each one.