Inflammatory Retinal Diseases — MCQs
Which of the following conditions is associated with granulomatous uveitis?
HLA marker of Behcet's syndrome is what?
Toxoplasma in children causes:
One year old male child with cat's reflex and raised IOP. What is the most likely diagnosis?
Statement 1 - A 59-year-old patient presents with flaccid bullae. Histopathology shows a suprabasal acantholytic split. Statement 2 - The row of tombstones appearance is diagnostic of Pemphigus vulgaris.
Which of the following is NOT a feature of CMV retinitis?
Which of the following statements is false regarding Eale's disease?
The best investigation for diagnosing Best disease is
What is the primary complication associated with Eale's disease?
What does the photostress test differentiate between?
Inflammatory Retinal Diseases Indian Medical PG Practice Questions and MCQs
Question 1: Which of the following conditions is associated with granulomatous uveitis?
- A. Fuchs' heterochromic iridocyclitis
- B. Behcet's disease
- C. Vogt-Koyanagi-Harada's disease (Correct Answer)
- D. Psoriatic arthritis
Explanation: ***Vogt-Koyanagi-Harada's disease*** - This systemic autoimmune condition characteristically presents with **bilateral, chronic granulomatous panuveitis**. - Other typical findings include **neurologic symptoms** (meningism, tinnitus) and **dermatologic manifestations** (vitiligo, poliosis, alopecia). *Fuchs' heterochromic iridocyclitis* - This condition is typically associated with **non-granulomatous anterior uveitis**. - Key features include **heterochromia** (different colored irises), diffuse stellate keratic precipitates, and often a cataract. *Behcet's disease* - Behcet's disease causes a **non-granulomatous panuveitis**, which is often recurrent and severe. - It is characterized by **recurrent oral and genital ulcers**, erythema nodosum, and pathergy. *Psoriatic arthritis* - Uveitis associated with psoriatic arthritis is usually **acute, unilateral, and non-granulomatous anterior uveitis**. - It is often seen in conjunction with **psoriatic skin lesions** and arthritis, commonly affecting the peripheral joints.
Question 2: HLA marker of Behcet's syndrome is what?
- A. B27
- B. DR5
- C. B51 (Correct Answer)
- D. CW6
Explanation: ***B51*** - **HLA-B51** is the most strongly associated genetic marker with **Behçet's syndrome**, particularly in populations from the Middle East and East Asia. - While not universally present in all Behçet's patients, its presence significantly increases susceptibility and is considered a **risk factor**. *B27* - **HLA-B27** is strongly associated with **seronegative spondyloarthropathies** such as ankylosing spondylitis, reactive arthritis, and psoriatic arthritis, [1] not Behçet's syndrome. - It plays a role in the pathogenesis of these conditions by influencing antigen presentation. [1] *DR5* - While various **HLA-DR alleles** are linked to autoimmune diseases (e.g., DR4 with rheumatoid arthritis, DR3 with SLE), **HLA-DR5** does not have a primary association with Behçet's syndrome. - Behçet's syndrome's primary genetic link is to Class I MHC alleles, specifically HLA-B51. *CW6* - **HLA-Cw6** is strongly associated with **psoriasis vulgaris**, [2] a chronic inflammatory skin condition. - It is not a recognized genetic marker for **Behçet's syndrome**.
Question 3: Toxoplasma in children causes:
- A. Chorioretinitis (Correct Answer)
- B. Keratitis
- C. Papillitis
- D. Conjunctivitis
Explanation: ***Chorioretinitis*** - **Toxoplasmosis** is a significant cause of **chorioretinitis** in children, particularly congenital infections. - Ocular toxoplasmosis often presents with **retinal lesions** that can lead to vision loss. *Conjunctivitis* - **Conjunctivitis** is an inflammation of the conjunctiva, typically caused by bacterial or viral infections. - While it can occur in children, it is not a primary or characteristic manifestation of **Toxoplasma infection**. *Keratitis* - **Keratitis** is an inflammation of the cornea, often caused by bacterial, viral, or fungal infections, or sometimes trauma. - Although eyes are affected by **Toxoplasma**, **keratitis** is not the typical ophthalmic presentation; **chorioretinitis** is. *Papillitis* - **Papillitis** refers to inflammation of the optic disc (optic nerve head). - While **Toxoplasma** can rarely affect the optic nerve, **papillitis** is not the most common or specific ocular manifestation compared to **chorioretinitis**.
Question 4: One year old male child with cat's reflex and raised IOP. What is the most likely diagnosis?
- A. Toxocara canis
- B. Retinopathy of prematurity
- C. Retinoblastoma (Correct Answer)
- D. Toxoplasma gondii infection
Explanation: ***Retinoblastoma*** - A **cat's reflex (leukocoria)**, which is a white pupillary reflex, is the most common presenting sign of retinoblastoma in children. - **Raised intraocular pressure (IOP)** can occur in advanced retinoblastoma due to secondary glaucoma caused by tumor growth or neovascularization. *Toxocara canis* - Ocular **toxocariasis** can cause leukocoria and inflammation, but it's typically associated with **granuloma formation** and not usually primary elevated IOP. - This condition is caused by a **parasitic infection** from roundworms, often seen in children with exposure to contaminated soil or pets. *Retinopathy of prematurity* - Primarily affects **premature infants** exposed to high oxygen, leading to abnormal retinal vessel development. - While it can cause leukocoria in severe stages, it would be unusual for a **one-year-old** to present with this primary diagnosis especially with raised IOP. *Toxoplasma gondii infection* - Ocular **toxoplasmosis** typically presents with **chorioretinitis** and can cause inflammation, but **leukocoria** and **raised IOP** are not its primary or most characteristic features. - This is a parasitic infection, congenital or acquired, often presenting with **retinal scars**.
Question 5: Statement 1 - A 59-year-old patient presents with flaccid bullae. Histopathology shows a suprabasal acantholytic split. Statement 2 - The row of tombstones appearance is diagnostic of Pemphigus vulgaris.
- A. Statements 1 & 2 are correct, 2 is not explaining 1 (Correct Answer)
- B. Statements 1 and 2 are correct and 2 is the correct explanation for 1
- C. Statements 1 and 2 are incorrect
- D. Statement 1 is incorrect
Explanation: ***Correct: Statements 1 & 2 are correct, 2 is not explaining 1*** **Analysis of Statement 1:** - A 59-year-old patient with **flaccid bullae** and **suprabasal acantholytic split** on histopathology is the classic presentation of **Pemphigus vulgaris** - The flaccid (easily ruptured) nature of bullae distinguishes it from tense bullae seen in bullous pemphigoid - The suprabasal location of the split (just above the basal layer) with acantholysis (loss of cell-to-cell adhesion) is pathognomonic - **Statement 1 is CORRECT** ✓ **Analysis of Statement 2:** - The **"row of tombstones" or "tombstone appearance"** is indeed a diagnostic histopathological feature of Pemphigus vulgaris - This appearance results from basal keratinocytes remaining attached to the basement membrane while suprabasal cells separate due to acantholysis - The intact basal cells standing upright resemble a row of tombstones - **Statement 2 is CORRECT** ✓ **Does Statement 2 explain Statement 1?** - Statement 2 describes a **histopathological appearance** (tombstone pattern) that is a **consequence** of the suprabasal split - However, it does NOT explain the **underlying cause** of the flaccid bullae or the suprabasal split - The true explanation involves **IgG autoantibodies against desmoglein 3 (and desmoglein 1)**, which attack intercellular adhesion structures (desmosomes), causing **acantholysis** - Therefore, **Statement 2 does NOT explain Statement 1** ✗ *Incorrect: Statement 2 is the correct explanation for Statement 1* - While both statements describe features of Pemphigus vulgaris, the tombstone appearance is a descriptive finding, not an explanatory mechanism *Incorrect: Statements 1 and 2 are incorrect* - Both statements are medically accurate descriptions of Pemphigus vulgaris features *Incorrect: Statement 1 is incorrect* - Statement 1 correctly describes the cardinal clinical and histopathological features of Pemphigus vulgaris
Question 6: Which of the following is NOT a feature of CMV retinitis?
- A. Perivasculitis
- B. Brush-fire appearance
- C. Immunosuppression
- D. Cracked mud appearance (Correct Answer)
Explanation: ***Cracked mud appearance*** - **"Cracked mud appearance"** is not a term used to describe CMV retinitis. The classic descriptions include **"pizza pie"**, **"cottage cheese and ketchup"**, and **"brush-fire"** appearances. - CMV retinitis presents with **necrotizing retinitis** with hemorrhages and granular opacification, not a cracked or atrophic pattern. - This option describes a **non-existent finding** in the context of CMV retinitis. *Immunosuppression* - **Immunosuppression**, especially due to **HIV/AIDS** (CD4 count <50 cells/μL), organ transplantation, or chemotherapy, is a **primary risk factor** for CMV retinitis. - It is crucial for the **reactivation** of latent CMV infection, leading to opportunistic disease. - While technically a predisposing condition rather than a "feature" of the disease itself, it is strongly associated with CMV retinitis. *Brush-fire appearance* - The **"brush-fire appearance"** is a classic description of CMV retinitis, referring to the **active leading edge** of the infection with confluent areas of necrosis and hemorrhage spreading across the retina. - This term captures the **fulminant necrotizing retinitis** with yellow-white retinal opacification and hemorrhages. *Perivasculitis* - **Perivasculitis**, or inflammation around the retinal blood vessels, is a **characteristic pathological feature** of CMV retinitis. - It often manifests as **frosted branch angiitis** (white sheathing around retinal vessels), which can be seen in severe cases.
Question 7: Which of the following statements is false regarding Eale's disease?
- A. Optic neuritis (Correct Answer)
- B. AKT is given
- C. Vitreous Hemorrhage
- D. Retinal detachment may occur
Explanation: ***Correct Answer: Optic neuritis*** - This statement is **false** because **Eale's disease** is a **peripheral retinal vasculitis** (periphlebitis) that primarily affects the **peripheral retinal veins**. - The condition does **NOT involve the optic nerve**, and **optic neuritis is NOT a recognized feature or complication** of Eale's disease. - The disease process is confined to the retinal vasculature and does not extend anteriorly to involve the optic disc or nerve in typical cases. *AKT is given* - While the exact etiology of Eale's disease remains uncertain, there is a **historical and clinical association with tuberculosis**, particularly in TB-endemic regions like India. - In clinical practice, **anti-tubercular therapy (ATT/AKT) is often empirically administered** when TB cannot be ruled out or when there is suspicion of systemic TB. - Some studies suggest ATT may help reduce inflammation and prevent recurrence in selected cases. *Vitreous Hemorrhage* - This is a **hallmark complication** of Eale's disease, particularly in stage 3 (proliferative stage). - **Recurrent vitreous hemorrhage** occurs due to rupture of fragile neovascular vessels that form in response to retinal ischemia. - It is one of the most common presentations requiring intervention. *Retinal detachment may occur* - **Tractional retinal detachment** is a recognized complication resulting from contraction of **fibrovascular proliferative membranes**. - **Rhegmatogenous retinal detachment** can also occur if vitreoretinal traction causes retinal breaks. - Both types may require surgical intervention (vitrectomy).
Question 8: The best investigation for diagnosing Best disease is
- A. Electrooculogram (EOG) (Correct Answer)
- B. Nerve conduction study (Electroneurogram)
- C. Electroretinogram (ERG)
- D. Electroencephalogram (EEG)
Explanation: ***Electrooculogram (EOG)*** - **Best disease** (Best vitelliform macular dystrophy) is a genetic disorder affecting the retinal pigment epithelium (RPE), leading to abnormal **light-induced changes in EOG potentials**. - A **significantly reduced or absent Arden ratio** (ratio of light peak to dark trough) on the **electrooculogram (EOG)** is pathognomonic for Best disease, even in early stages when vision may be unaffected. *Nerve conduction study (Electroneurogram)* - A **nerve conduction study** measures the speed and strength of electrical signals as they travel through peripheral nerves. - This test is used for diagnosing conditions affecting **peripheral nerves**, such as neuropathies, and has no relevance to retinal disorders. *Electroretinogram (ERG)* - An **electroretinogram (ERG)** measures the electrical responses of the **photoreceptors and inner retinal cells** to light stimulation. - While ERG is useful in diagnosing various retinal disorders, it usually shows a **normal or nearly normal result in Best disease**, as the primary defect is in the RPE and not the photoreceptors themselves early in the disease course. *Electroencephalogram (EEG)* - An **electroencephalogram (EEG)** records the electrical activity of the **brain**. - It is primarily used to diagnose conditions like **epilepsy, sleep disorders**, and other neurological conditions affecting brain function, and has no utility in diagnosing retinal diseases.
Question 9: What is the primary complication associated with Eale's disease?
- A. Retinal hemorrhage
- B. Vitreous hemorrhage (Correct Answer)
- C. Conjunctival hemorrhage
- D. Choroidal hemorrhage
Explanation: ***Vitreous hemorrhage*** - **Vitreous hemorrhage** is a common and often visually debilitating complication of Eale's disease, resulting from the rupture of fragile new vessels. - The proliferative stage of Eale's disease involves the development of **neovascularization** on the retina, which can bleed into the vitreous humor. *Retinal hemorrhage* - While **retinal hemorrhages** can occur in Eale's disease, they are often precursors to or components of vitreous hemorrhage, not the primary, most significant complication. - Retinal hemorrhages alone may cause less severe vision loss compared to the extensive obscuration by vitreous bleeding. *Conjunctival hemorrhage* - **Conjunctival hemorrhage** involves bleeding in the superficial layers of the eye and is not typically associated with the underlying vasculitis of Eale's disease. - This is a benign condition and not a primary complication of a retinal vascular disorder. *Choroidal hemorrhage* - **Choroidal hemorrhage** occurs beneath the retina and is usually associated with trauma, surgery, or degenerative conditions like age-related macular degeneration, not Eale's disease. - Eale's disease primarily affects the **retinal vasculature**, leading to bleeding internally into the vitreous.
Question 10: What does the photostress test differentiate between?
- A. Macular and optic nerve diseases (Correct Answer)
- B. Retinal diseases and other conditions
- C. Cataract and retinal diseases
- D. Vitreous diseases and optic nerve diseases
Explanation: ***Macular and optic nerve diseases*** - The **photostress test** is specifically designed to differentiate between **macular (retinal) disease** and **optic nerve disease** when both present with decreased visual acuity. - The test works by exposing the eye to bright light, which bleaches photopigments in the photoreceptors, then measuring the **time to visual recovery**. - **Normal recovery (<60 seconds)** suggests intact macular function, pointing toward **optic nerve disease** as the cause of vision loss. - **Prolonged recovery (>90 seconds)** indicates **macular dysfunction**, confirming a **retinal/macular pathology**. - This is a classic bedside test to localize the pathology when examining patients with unexplained visual loss. *Retinal diseases and other conditions* - While the test does assess retinal/macular function, this option is too vague and non-specific. - The key clinical utility is the specific differentiation between **macular vs. optic nerve** pathology, not a general "other conditions." *Cataract and retinal diseases* - **Cataract** causes optical blur from lens opacity but does not prolong photostress recovery time. - The photostress test measures **photoreceptor recovery**, which is unaffected by media opacities like cataract. - This is not the primary clinical differentiation for which the test is used. *Vitreous diseases and optic nerve diseases* - **Vitreous diseases** (hemorrhage, floaters, detachment) affect light transmission but do not impact **photoreceptor recovery time**. - The test does not assess vitreous pathology and this is not its clinical indication.
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