The condition presented below is caused due to:

Combined AIIMS - 2020 (Jodhpur, Bhopal, Patna, Raipur)

Medical & Surgical Nursing

Easy

Appeared in: Combined AIIMS - 2020 (Jodhpur, Bhopal, Patna, Raipur)

Explanation

The image shows exophthalmos, the forward protrusion of the eyeballs, which is a classic sign of Graves' ophthalmopathy.
Graves' disease is the most common cause of hyperthyroidism, an autoimmune condition where antibodies stimulate the thyroid gland.
The mechanism involves inflammation and accumulation of fluid and glycosaminoglycans in the retro-orbital tissues (muscles and fat), which pushes the eyeballs forward.
Other signs of hyperthyroidism include heat intolerance, weight loss, tachycardia, and nervousness.

Option A: Glaucoma is characterized by increased intraocular pressure that damages the optic nerve. It does not cause the eyeballs to protrude.
Option C: Hypothyroidism (underactive thyroid) typically causes periorbital edema (puffiness around the eyes) due to myxedema, not the distinct forward bulging (proptosis) seen in the image.
Option D: Hypopituitarism is a deficiency of pituitary hormones. While it can cause a wide range of symptoms, it is not associated with exophthalmos.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Pathophysiology of Endocrine Disorders and Associated Clinical Signs as background academic context rather than a clinical decision trigger.
Nurses must recognize exophthalmos as a key sign of hyperthyroidism, prompting further assessment and referral. Patient education on eye care is critical.
Nursing interventions for exophthalmos include administering artificial tears to prevent corneal drying, advising the use of sunglasses to reduce photophobia, and suggesting sleeping with the head of the bed elevated to decrease periorbital edema.
Patient safety is paramount. The nurse must assess for incomplete lid closure (lagophthalmos), which increases the risk of corneal abrasion and infection. Any changes in vision must be reported immediately.

How to Approach the Question

First, carefully analyze the image to identify the primary clinical sign. In this case, the key finding is the prominent bulging of the eyes.
Identify the medical term for this sign, which is exophthalmos or proptosis.
Next, review the provided options, which are all endocrine or ophthalmologic conditions.
Systematically evaluate each option by recalling its typical signs and symptoms. Ask yourself, 'Which of these conditions is known to cause exophthalmos?'
Correlate your medical knowledge with the visual evidence. Hyperthyroidism (specifically Graves' disease) is the classic cause of exophthalmos. The other options (Glaucoma, Hypothyroidism, Hypopituitarism) do not present with this sign.
Select the option that provides the most direct and well-known causal link to the visual finding.

Concept Tested & Keywords

Concept Tested: Pathophysiology of Endocrine Disorders and Associated Clinical Signs
Stem keywords: condition presented, caused due to
Lead-in keywords: caused due to
Clinical cues: Image showing bilateral exophthalmos (protruding eyes) with scleral show, which is a hallmark sign of thyroid eye disease.

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