{"id":2222,"date":"2022-11-16T20:21:00","date_gmt":"2022-11-16T20:21:00","guid":{"rendered":"https:\/\/www.osmosis.org\/blog\/?p=2222"},"modified":"2026-02-19T17:44:53","modified_gmt":"2026-02-20T01:44:53","slug":"usmle-step-2-ck-question-of-the-day-purulent-eye-discharge","status":"publish","type":"post","link":"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-purulent-eye-discharge","title":{"rendered":"USMLE\u00ae Step 2 CK Question of the Day: Purulent Eye Discharge"},"content":{"rendered":"<div id=\"ez-toc-container\" class=\"ez-toc-v2_0_80 ez-toc-wrap-center counter-hierarchy ez-toc-counter ez-toc-custom ez-toc-container-direction\">\n<div class=\"ez-toc-title-container\">\n<p class=\"ez-toc-title\" style=\"cursor:inherit\">In This Article<\/p>\n<span class=\"ez-toc-title-toggle\"><a href=\"#\" class=\"ez-toc-pull-right ez-toc-btn ez-toc-btn-xs ez-toc-btn-default ez-toc-toggle\" aria-label=\"Toggle Table of Content\"><span class=\"ez-toc-js-icon-con\"><span class=\"\"><span class=\"eztoc-hide\" style=\"display:none;\">Toggle<\/span><span class=\"ez-toc-icon-toggle-span\"><svg style=\"fill: #999;color:#999\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" class=\"list-377408\" width=\"20px\" height=\"20px\" viewBox=\"0 0 24 24\" fill=\"none\"><path d=\"M6 6H4v2h2V6zm14 0H8v2h12V6zM4 11h2v2H4v-2zm16 0H8v2h12v-2zM4 16h2v2H4v-2zm16 0H8v2h12v-2z\" fill=\"currentColor\"><\/path><\/svg><svg style=\"fill: #999;color:#999\" class=\"arrow-unsorted-368013\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"10px\" height=\"10px\" viewBox=\"0 0 24 24\" version=\"1.2\" baseProfile=\"tiny\"><path d=\"M18.2 9.3l-6.2-6.3-6.2 6.3c-.2.2-.3.4-.3.7s.1.5.3.7c.2.2.4.3.7.3h11c.3 0 .5-.1.7-.3.2-.2.3-.5.3-.7s-.1-.5-.3-.7zM5.8 14.7l6.2 6.3 6.2-6.3c.2-.2.3-.5.3-.7s-.1-.5-.3-.7c-.2-.2-.4-.3-.7-.3h-11c-.3 0-.5.1-.7.3-.2.2-.3.5-.3.7s.1.5.3.7z\"\/><\/svg><\/span><\/span><\/span><\/a><\/span><\/div>\n<nav><ul class='ez-toc-list ez-toc-list-level-1 ' ><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-1\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-purulent-eye-discharge\/#The_correct_answer_to_todays_USMLE%C2%AE_Step_2_CK_Question_is%E2%80%A6\" >The correct answer to today&#8217;s USMLE\u00ae Step 2 CK Question is&#8230;<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-2\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-purulent-eye-discharge\/#Incorrect_Answer_Explanations\" >Incorrect Answer Explanations<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-3\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-purulent-eye-discharge\/#Main_Explanation\" >Main Explanation<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-4\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-purulent-eye-discharge\/#Major_Takeaway\" >Major Takeaway<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-5\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-purulent-eye-discharge\/#References\" >References<\/a><\/li><\/ul><\/nav><\/div>\n\n<p class=\"wp-block-paragraph\"><em>Here&#8217;s another <strong>USMLE\u00ae Step 2 CK <\/strong>Question of the Day!\u00a0Today&#8217;s case involves a 3-day-old male infant with a purulent discharge from the eyes and associated edema of the upper and lower eyelids. What&#8217;s the <strong>diagnosis<\/strong>? Let&#8217;s find out!<\/em><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A <strong>3-day-old male infant<\/strong> is brought to the <strong>pediatric emergency department<\/strong> for evaluation of <strong>purulent discharge<\/strong> from both eyes for the past day. The patient was born at <strong>40 weeks gestation<\/strong> via vaginal delivery at home. He has been breastfed exclusively. Vitals are within normal limits. Physical examination demonstrates <strong>bilateral conjunctival injection, purulent discharge from the eyes, <\/strong>and <strong>associated edema of the upper and lower eyelids<\/strong>. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Which of the following <em>medications <\/em>is used to prevent this patient\u2019s clinical condition?<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A. Ophthalmic erythromycin<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B. Intravenous acyclovir<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C. Intravenous ganciclovir<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D. Intravenous ceftriaxone<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>E. Ophthalmic levofloxacin<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>F. Oral erythromycin<\/strong><\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"The_correct_answer_to_todays_USMLE%C2%AE_Step_2_CK_Question_is%E2%80%A6\"><\/span>The correct answer to today&#8217;s USMLE\u00ae Step 2 CK Question is&#8230;<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A.&nbsp;Ophthalmic erythromycin<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><em>Before we get to the Main Explanation, let&#8217;s see why the answer wasn&#8217;t B, C, D, or E. Skip to the bottom if you want to see the correct answer right away!<\/em><\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Incorrect_Answer_Explanations\"><\/span>Incorrect Answer Explanations<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B. Intravenous acyclovir<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:&nbsp;<\/strong>Intravenous acyclovir is an effective treatment for <strong>neonatal herpes simplex infection<\/strong>, which instead presents with <strong>excessive watery discharge<\/strong> from the eyes, eye pain, and conjunctival erythema. If untreated, patients can develop <strong>irreversible vision impairment <\/strong>or <strong>blindness<\/strong>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C. Intravenous ganciclovir<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:&nbsp;<\/strong>Ganciclovir is an effective treatment for patients with <strong>cytomegalovirus (CMV)-induced retinitis<\/strong>. This neonates patient\u2019s presentation, however, is more consistent with bacterial conjunctivitis.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D. Intravenous ceftriaxone<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong>&nbsp;Intravenous ceftriaxone is an appropriate treatment for <strong>gonococcal conjunctivitis<\/strong>, but it would not have prevented the condition even if given initially at the time of delivery.&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>E. Ophthalmic levofloxacin<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong>&nbsp;Ophthalmic levofloxacin is useful in patients presenting with <strong>bacterial conjunctivitis<\/strong> caused by <strong>Staphylococcus aureus <\/strong>or <strong>Haemophilus influenzae<\/strong>. It is not useful against N. gonorrhoeae, nor is it used prophylactically in the prevention of gonococcal conjunctivitis.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>F. Oral erythromycin<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:&nbsp;<\/strong>Oral erythromycin is the preferred treatment for <strong>neonatal C. trachomatis <\/strong>infections, including both <strong>conjunctivitis <\/strong>and <strong>pneumonia<\/strong>. C. trachomatis typically presents <strong>5-14 days after birth<\/strong> with <strong>mucopurulent discharge<\/strong>, as opposed to this neonate\u2019s discharge, which is purulent. Additionally, oral erythromycin is not used for prophylaxis of gonococcal conjunctivitis.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Main_Explanation\"><\/span>Main Explanation<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">This <strong>neonate<\/strong>, recently born at home, is presenting with purulent eye discharge and <strong>bilateral eyelid swelling<\/strong>, consistent with gonococcal conjunctivitis. <strong>Ophthalmic erythromycin<\/strong> is routinely applied at birth to prevent the development of this condition.&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Neonates are at higher risk of <strong>conjunctivitis <\/strong>due to <strong>decreased tear production, lack of IgA in tears, poor native immune function, <\/strong>and <strong>absence of lymphoid tissue in conjunctiva<\/strong>. Neonatal conjunctivitis, also called <strong>ophthalmia neonatorum<\/strong>, typically presents during the <strong>first four weeks of life<\/strong> and is usually <strong>acquired from the mother<\/strong> (as the patient passes through the birth canal) or following the application of <strong>chemical agents<\/strong>.&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The <strong>age <\/strong>of the neonate is an important clue in determining the <strong>etiology <\/strong>of neonatal conjunctivitis:&nbsp;<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>First 24 hrs of life: Chemical causes from prophylactic medications, such as silver nitrate drops (now rarely used because of the increased risk of chemical conjunctivitis) or erythromycin drops for gonococcal conjunctivitis<\/strong><\/li>\n\n\n\n<li><strong>24 &#8211; 48 hrs of life: Bacterial causes are most likely (Neisseria gonorrhoeae is the most common cause in the time range, Staphylococcus aureus).&nbsp;<\/strong><\/li>\n\n\n\n<li><strong>5 &#8211; 14 days of life: Chlamydia trachomatis&nbsp;<\/strong><\/li>\n\n\n\n<li><strong>6 &#8211; 14 days of life: Herpes keratoconjunctivitis&nbsp;<\/strong><\/li>\n<\/ul>\n\n\n\n<figure class=\"wp-block-image aligncenter size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"1080\" height=\"577\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2022\/11\/neonatal-conjunctivitis-large.png\" alt=\"DIFFERENTIAL DIAGNOSIS OF NEONATAL CONJUNCTIVITIS\n\nCAUSE \/ ONSET \/ FINDINGS \/ CYTOLOGY AND LABORATORY TESTS\n\nTOXIC (e.g., Silver nitrate) \/ Within hours \/ Hyperemia, slight watery to mucoid discharge \/ Negative culture\n\nNEISSERIA GONORRHOE AE (CONOCOCCAL CONJUNCTIVITIS)\n2nd-4th day of life (preventable with ophthalmic erythromycin) \/ Acute purulent conjunctivitis \/ Intracellular Gram-negative diplococci; positive culture on blood agar and chocolate agar (Thayer-Martin agar).\n\nOTHER BACTERIA (PSEUDOMONAS AERUGINOSA, STAPHYLOCCUCUS AUREUS, HAEMOPHILUS) \/ 4th-5th day of life \/ Mucopurulent conjunctivitis \/ Gram-positive or Gram-negative organisms; positive culture on blood agar\n\nCHLAYMYDIA \/ 5th-14th day of life \/ Mucopurulent conjunctivitis, less frequently purulent, Viscous mucus \/ Giemsa-positive cytoplasmic inclusion bodies in epithelial cells; negative culture\n\nHERPES SIMPLEX VIRUS \/ 5th-7th day of life \/ Corneal involvement, Systemic manifestations \/ Multinucleated giant cells, cytoplasmic inclusion bodies; negative culture\" class=\"wp-image-4612\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2022\/11\/neonatal-conjunctivitis-large.png 1080w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2022\/11\/neonatal-conjunctivitis-large.png?resize=300,160 300w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2022\/11\/neonatal-conjunctivitis-large.png?resize=768,410 768w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2022\/11\/neonatal-conjunctivitis-large.png?resize=1024,547 1024w\" sizes=\"auto, (max-width: 1080px) 100vw, 1080px\" \/><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Major_Takeaway\"><\/span>Major Takeaway<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Neonatal conjunctivitis can be differentiated based on the <strong>timeline of symptom onset<\/strong>; if neonates develop conjunctivitis <strong>within the first 5 days of birth<\/strong>, it is likely <strong>gonococcal conjunctivitis<\/strong>, whereas if it occurs <strong>within the first 5 to 14 days of life<\/strong>, it is likely <strong>Chlamydial conjunctivitis<\/strong>. Gonococcal conjunctivitis is preventable with the routine application of <strong>ophthalmic erythromycin<\/strong> at the time of birth.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"References\"><\/span>References<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Makker K, Nassar GN, Kaufman EJ.&nbsp;<em>Neonatal<\/em>&nbsp;<em>Conjunctivitis<\/em>. [Updated 2020 Jul 21]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from:&nbsp;<a href=\"https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK441840\/\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK441840\/<\/a><\/li>\n<\/ul>\n\n\n\n<figure class=\"wp-block-image size-large\"><a href=\"https:\/\/www.osmosis.org\/plans\"><img loading=\"lazy\" decoding=\"async\" width=\"700\" height=\"250\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2020\/09\/Blog_Display_Ads_MD1_2023.png?w=700\" alt=\"\" class=\"wp-image-5904\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2020\/09\/Blog_Display_Ads_MD1_2023.png 700w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2020\/09\/Blog_Display_Ads_MD1_2023.png?resize=300,107 300w\" sizes=\"auto, (max-width: 700px) 100vw, 700px\" \/><\/a><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><em><strong>Want more USMLE\u00ae Step 2 CK practice questions? Try Osmosis from Elsevier today! Access your&nbsp;<em><a href=\"https:\/\/www.osmosis.org\/plans\" target=\"_blank\" rel=\"noreferrer noopener\">free trial<\/a><\/em>&nbsp;and discover why millions of current and future clinicians and caregivers love learning with us.<\/strong><\/em><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n","protected":false},"excerpt":{"rendered":"<p>A 3-day-old infant with purulent eye discharge likely has gonococcal conjunctivitis. Learn why ophthalmic erythromycin is the preventive treatment of choice for newborns.<\/p>\n","protected":false},"author":202,"featured_media":2224,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[27,20,16,1366,1370,45],"tags":[2007,449,2006,614,84,716,2001,2008,2009,2003,2004,2002,2005,1331,952],"class_list":["post-2222","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-medicine","category-exam-prep","category-do","category-questions","category-step-2-questions","category-step-2","tag-bacterial-conjunctivitis","tag-clinical-cases","tag-gonococcal-conjunctivitis","tag-infectious-diseases","tag-medical-education","tag-neonatal-care","tag-neonatal-conjunctivitis","tag-neonatal-ophthalmia","tag-newborn-antibiotics","tag-newborn-eye-infection","tag-newborn-prophylaxis","tag-ophthalmic-erythromycin","tag-ophthalmology","tag-pediatric-emergency","tag-usmle-step-2-ck"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v23.6 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>USMLE\u00ae Step 2 CK Question of the Day: Purulent Eye Discharge - Osmosis Blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-purulent-eye-discharge\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"USMLE\u00ae Step 2 CK Question of the Day: Purulent Eye Discharge - Osmosis Blog\" \/>\n<meta property=\"og:description\" content=\"A 3-day-old infant with purulent eye discharge likely has gonococcal conjunctivitis. 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