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JODHPUR AIIMS SNO-2018
Medical Surgical Nursing
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Kayser-Fleisher (golden brown) ring at the limbus of corner seen with a hand lens is observed in?

Appeared in: JODHPUR AIIMS SNO-2018

Explanation

  • Wilson's Disease is an autosomal recessive genetic disorder that causes an accumulation of copper in the body.
  • This excess copper gets deposited in various organs, including the liver, brain, and eyes.
  • In the eye, copper deposits in the Descemet's membrane of the cornea, creating a visible golden-brown ring known as the Kayser-Fleischer ring.
  • This sign is present in almost all patients with neurologic or psychiatric symptoms of Wilson's Disease and is a key diagnostic feature.

Why Other Options Were Wrong

  • Option A: Down's Syndrome is a genetic condition (Trisomy 21) that is not associated with copper metabolism or Kayser-Fleischer rings.
  • Option B: A cataract is the clouding or opacification of the lens inside the eye, which leads to blurry vision. It does not cause a colored ring on the cornea.
  • Option C: Glaucoma is a group of eye conditions that damage the optic nerve, often due to high intraocular pressure. Its characteristic sign is 'cupping' of the optic disc, not a corneal ring.

Related Visual

Visual explanation — Related Visual
Clinical Relevance
  • Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Ocular manifestations of systemic diseases as background academic context rather than a clinical decision trigger.
  • The identification of a Kayser-Fleischer ring is a critical nursing observation that can lead to the diagnosis of a serious, but treatable, systemic disease.
  • Nurses should understand that this ocular sign warrants immediate referral for further investigation, including serum ceruloplasmin levels and 24-hour urinary copper excretion tests.
  • Early diagnosis and lifelong treatment with copper-chelating agents (like penicillamine) or zinc salts can prevent irreversible liver failure and severe neurological damage.
How to Approach the Question
  • Step 1: Identify the key clinical sign described in the question stem, which is the 'Kayser-Fleisher (golden brown) ring at the limbus of corner'.
  • Step 2: Observe the provided image, which visually confirms the presence of this specific ring around the cornea.
  • Step 3: Access your medical knowledge to recall the systemic disease classically associated with this pathognomonic sign.
  • Step 4: Evaluate the given options. Wilson's Disease is the well-known cause of Kayser-Fleischer rings due to copper deposition.
  • Step 5: Rule out the other options by recalling their distinct ocular manifestations: Down's Syndrome (Brushfield spots), Cataract (lens opacity), and Glaucoma (optic disc cupping).
Concept Tested & Keywords
  • Concept Tested: Ocular manifestations of systemic diseases
  • Stem keywords: Kayser-Fleisher ring, golden brown ring, limbus of cornea
  • Lead-in keywords: observed in
  • Clinical cues: The presence of a specific, named clinical sign (Kayser-Fleischer ring) is the central clue.

Question ID

QxZjwRDxM3YqAWOJ4zbc_p

Reference Book

E6 Medicine Harrison 22e Part 2 pp. 1243-1245, 1422-1424

E6 Robert Boland, Marcia L. Verduin - Kaplan and Sadock's Comprehensive Text of Psychiatry-Wolters Kluwer Health (2024) (pp 1-16525 of 16525) p. 2296-2298

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