Diseases of the Retina Practice Questions

Q: A patient presents with detachment of the retina accompanied by photopsia and floaters. What is the most likely diagnosis?

Rhegmatogenous retinal detachment. ### **Explanation** **1. Why Rhegmatogenous Retinal Detachment (RRD) is correct:** Rhegmatogenous RD is the most common type of retinal detachment, caused by a **break (rhegma)** in the sensory retina. This allows liquefied vitreous to enter the subretinal space, separating the neurosensory retina from the retinal pigment epithelium (RPE). The classic clinical triad for RRD includes: * **Photopsia (Flashing lights):** Caused by vitreoretinal traction stimulating the retina. * **Floaters:** Resulting from vitreous condensation or a **Shafer’s sign** (tobacco dust/RPE cells in the anterior vitreous). * **Field Defect:** Described as a "curtain falling" over the vision. **2. Why the other options are incorrect:** * **Vitreous Hemorrhage:** While it presents with sudden floaters, it does not typically cause retinal detachment unless associated with underlying proliferative retinopathy. * **Exudative RD:** Caused by fluid accumulation (e.g., inflammation or tumors) without a retinal break. It is characterized by **shifting fluid** and usually lacks photopsia or floaters because there is no vitreous traction. * **Tractional RD:** Caused by fibrovascular membranes pulling the retina (common in Diabetic Retinopathy). It is typically slow-progressing, lacks photopsia (as traction is static), and the detachment is concave in shape. **3. NEET-PG High-Yield Pearls:** * **Shafer’s Sign:** Pathognomonic for a retinal tear/RRD (pigment cells in the vitreous). * **Configuration:** RRD is **convex** and extends to the ora serrata; Tractional RD is **concave** and does not reach the ora serrata. * **Management:** RRD is a surgical emergency. The goal is to seal the break using **Cryopexy or Laser photocoagulation**, followed by Scleral buckling or Pars Plana Vitrectomy.

Q: Which of the following is NOT a risk factor for rhegmatogenous retinal detachment?

Diabetes. **Explanation:** Rhegmatogenous Retinal Detachment (RRD) is characterized by a full-thickness break (hole or tear) in the neurosensory retina, allowing liquefied vitreous to enter the subretinal space. **Why Diabetes is the Correct Answer:** Diabetes Mellitus is primarily associated with **Tractional Retinal Detachment (TRD)**, not rhegmatogenous. In proliferative diabetic retinopathy (PDR), neovascularization leads to the formation of fibrovascular membranes. These membranes contract, pulling the neurosensory retina away from the retinal pigment epithelium (RPE) without necessarily causing a retinal break. **Analysis of Incorrect Options (Risk Factors for RRD):** * **High Myopia (Option B):** This is the most common predisposing factor. Myopic eyes have longer axial lengths, thinner peripheral retinas, and are prone to lattice degeneration and early vitreous liquefaction, increasing the risk of tears. * **Aphakia (Option A) and Pseudophakia (Option D):** Intraocular surgeries, especially cataract extraction, significantly increase RRD risk. This is due to forward movement of the vitreous (internal tamponade loss) and vitreoretinal traction during or after surgery (e.g., YAG capsulotomy). **High-Yield Clinical Pearls for NEET-PG:** * **Most common type of RD:** Rhegmatogenous. * **Most common precursor to RRD:** Lattice degeneration (found in ~8% of the general population). * **Classic Symptoms:** Photopsia (flashes), sudden onset of floaters, and a "curtain-like" visual field loss. * **Shafer’s Sign:** Presence of "tobacco dust" (RPE cells) in the anterior vitreous; pathognomonic for a retinal tear. * **Management:** RRD requires surgical intervention (Scleral buckling, Pneumatic retinopexy, or Pars Plana Vitrectomy) to close the break.

Q: Trucking of vessels is seen in which of the following disorders?

Central retinal artery occlusion. **Explanation:** **Central Retinal Artery Occlusion (CRAO)** is the correct answer. The term **"trucking"** (also known as **cattle-trucking** or **segmentation**) refers to the fragmentation of the blood column within the retinal arterioles. This occurs due to a complete or near-complete cessation of blood flow, causing the red blood cells to clump together and move in segments, separated by clear plasma. This is a hallmark sign of a profound, acute ischemic event in the retina. **Why the other options are incorrect:** * **Central Retinal Vein Occlusion (CRVO):** Characterized by "blood and thunder" fundus (extensive flame-shaped hemorrhages), dilated tortuous veins, and disc edema, but not segmentation of the arterial column. * **Hypertensive Retinopathy:** Features include arteriolar narrowing, AV nicking, copper/silver wiring, and cotton wool spots. While vessels change caliber, they do not exhibit the "trucking" phenomenon. * **Sickle Cell Retinopathy:** Known for "sea-fan" neovascularization, salmon-patch hemorrhages, and black sunburst lesions. While it involves vaso-occlusion, "trucking" is not its defining clinical sign. **High-Yield Clinical Pearls for NEET-PG:** 1. **Cherry Red Spot:** The most famous sign of CRAO, caused by the contrast between the opaque, edematous ischemic retina and the thin fovea showing the underlying choroidal vasculature. 2. **Cilioretinal Artery:** In ~15-20% of the population, this artery (derived from ciliary circulation) spares the macula, preserving central vision despite CRAO. 3. **Management:** CRAO is an ocular emergency. Immediate measures include digital ocular massage, anterior chamber paracentesis, and IV acetazolamide to lower IOP and dislodge the embolus.

Q: Which instrument is used for fundus examination?

Fundus Examination. **Explanation:** The **Ophthalmoscope** (Direct or Indirect) is the primary instrument used for **Fundus Examination**. The "fundus" refers to the interior surface of the eye opposite the lens, including the retina, optic disc, macula, and posterior pole. * **Why Option B is Correct:** Funduscopy (Ophthalmoscopy) allows the clinician to visualize the posterior segment of the eye. It is essential for diagnosing retinal detachments, diabetic retinopathy, and hypertensive changes. * **Why Option A is Incorrect:** While the optic disc is *part* of the fundus, "Fundus Examination" is the more comprehensive and clinically accurate term for the procedure. * **Why Option C is Incorrect:** Corneal examination is primarily performed using a **Slit-lamp biomicroscope** or a **Placido disc** (for curvature). * **Why Option D is Incorrect:** Examination of the angle of the anterior chamber requires a specialized lens called a **Goniolens** (Gonioscopy), as the angle cannot be seen directly due to total internal reflection. **High-Yield Clinical Pearls for NEET-PG:** 1. **Direct Ophthalmoscope:** Provides a virtual, erect image with high magnification (15x) but a small field of view (approx. 10°). 2. **Indirect Ophthalmoscope:** Provides a real, inverted image with lower magnification (approx. 3x-5x) but a wider field of view (approx. 37°). It allows for **stereopsis** (3D view) and examination of the peripheral retina up to the ora serrata. 3. **Gold Standard:** For detailed macular evaluation, a **90D or 78D non-contact lens** used with a slit lamp is preferred.

Q: Central Retinal artery occlusion is known to be associated with which of the following conditions?

Orbital mucomycosis. **Explanation:** **Correct Answer: D. Orbital mucormycosis** **Medical Concept:** Orbital mucormycosis is a fulminant fungal infection, typically seen in immunocompromised patients (e.g., uncontrolled diabetes or post-COVID-19). The fungus (*Mucorales*) is **angioinvasive**, meaning it directly invades the walls of blood vessels. This leads to vasculitis, thrombosis, and subsequent tissue infarction. When the infection spreads to the orbit, it can cause thrombosis of the **Central Retinal Artery (CRAO)** or the ophthalmic artery, leading to sudden, painless loss of vision. **Analysis of Incorrect Options:** * **A. Panophthalmitis:** This is an intense inflammation of all coats of the eye, including the Tenon’s capsule. While it causes severe vision loss, it is characterized by global ocular destruction and suppuration rather than a specific vascular occlusion like CRAO. * **B. Diabetic Retinopathy:** This is a microangiopathy characterized by capillary basement membrane thickening and pericyte loss. It leads to chronic ischemia and neovascularization, but it does not typically present as an acute CRAO. * **C. CMV Retinitis:** This is an opportunistic viral infection (common in AIDS) that causes "pizza-pie" fundus (retinal necrosis and hemorrhage). It destroys the retinal tissue directly rather than causing a primary arterial occlusion. **High-Yield Clinical Pearls for NEET-PG:** * **CRAO Fundus Findings:** Look for a "Cherry Red Spot" at the fovea (due to the visible choroidal vasculature through the thin fovea) and "cattle-trucking" (segmentation) of blood in the retinal veins. * **Mucormycosis Triad:** Sinusitis, orbital cellulitis (proptosis/ophthalmoplegia), and black eschar on the palate or nasal mucosa. * **Emergency Management:** CRAO is an ocular emergency. Immediate measures include digital ocular massage, anterior chamber paracentesis, and inhaled carbogen to induce vasodilation.

Q: The Amsler grid test is primarily used for the diagnosis of which condition?

Age-related macular degeneration. **Explanation:** The **Amsler Grid** is a simple, non-invasive clinical tool used to monitor the central **10 degrees** of the visual field. It is primarily used to detect and monitor diseases affecting the **macula**. **Why B is Correct:** In **Age-related Macular Degeneration (ARMD)**, particularly the "wet" (exudative) type, subretinal neovascularization or macular edema causes the retinal layers to become distorted. When a patient looks at the straight lines of the Amsler grid, this distortion results in **metamorphopsia** (wavy lines) or **scotomas** (missing areas/blind spots). It is the gold standard for home monitoring in ARMD patients to detect early progression. **Why the other options are incorrect:** * **A. Retinitis Pigmentosa:** This condition primarily affects the peripheral retina (rods), leading to "tunnel vision" and night blindness. The Amsler grid, which tests the central field, is not the primary diagnostic tool. * **C. Optic Atrophy:** This involves damage to the optic nerve. While it can cause central scotomas, it is typically diagnosed via fundoscopy (pale disc) and formal automated perimetry (e.g., Humphrey Visual Field). * **D. Choroiditis:** While posterior uveitis can affect the macula, the Amsler grid is not the specific diagnostic test for inflammation of the choroid. **NEET-PG High-Yield Pearls:** * **Testing Distance:** The grid is held at a normal reading distance (**30 cm**) with near-correction (reading glasses) on. * **Metamorphopsia:** This is the hallmark symptom detected by the Amsler grid. * **Micropsia vs. Macropsia:** Edema pushing photoreceptors apart causes *micropsia*; crowding of receptors causes *macropsia*. * **Other uses:** It can also be used to monitor **Central Serous Chorioretinopathy (CSCR)** and **Cystoid Macular Edema (CME)**.

Q: Which of the following is NOT an AR disorder?

Butterfly macular dystrophy. **Explanation:** The correct answer is **Butterfly macular dystrophy**, which is an **Autosomal Dominant (AD)** disorder. It belongs to a group of conditions known as **Pattern Dystrophies**, most commonly caused by mutations in the **PRPH2 gene** (Peripherin-2). Clinically, it is characterized by pigment deposition in the macula resembling the wings of a butterfly, usually presenting with a mild, late-onset reduction in vision. **Analysis of other options:** * **Gyrate Atrophy:** This is an **Autosomal Recessive (AR)** metabolic disorder caused by a deficiency of the enzyme ornithine aminotransferase (OAT). It leads to high plasma ornithine levels and characteristic "punched-out" chorioretinal atrophy. * **Goldmann-Favre Syndrome:** This is an **AR** condition characterized by early-onset night blindness, retinoschisis (foveal and peripheral), and pigmentary degeneration. It is associated with mutations in the **NR2E3 gene**. * **Bardet-Biedl Syndrome:** This is a classic **AR** ciliopathy. It presents with a pentad of features: pigmentary retinopathy, polydactyly, obesity, hypogonadism, and renal anomalies. **High-Yield Clinical Pearls for NEET-PG:** 1. **PRPH2 Gene:** Remember this gene for multiple pattern dystrophies (Butterfly, Reticular, Adult-onset vitelliform). 2. **Gyrate Atrophy Treatment:** Managed with a **Vitamin B6 (Pyridoxine)** supplement and a low-protein (low-arginine) diet. 3. **Inheritance Patterns:** Most metabolic retinal disorders are AR, while many structural/pattern dystrophies are AD. 4. **Stargardt Disease:** The most common AR macular dystrophy (ABCA4 mutation).

Q: Which of the following conditions has autosomal dominant inheritance?

Best disease. **Explanation:** The correct answer is **Best disease** (Best Vitelliform Macular Dystrophy). This condition is characterized by an **Autosomal Dominant (AD)** inheritance pattern, caused by a mutation in the **BEST1 gene** on chromosome 11q13, which encodes the protein bestrophin-1. This leads to an accumulation of lipofuscin within the retinal pigment epithelium (RPE), resulting in the classic "egg-yolk" appearance on fundoscopy. **Analysis of Incorrect Options:** * **Gyrate Atrophy:** This is an **Autosomal Recessive (AR)** metabolic disorder caused by a deficiency of the enzyme ornithine aminotransferase, leading to hyperornithinemia and progressive chorioretinal atrophy. * **Laurence-Moon-Biedl (Bardet-Biedl) Syndrome:** This is an **AR** ciliopathy characterized by retinitis pigmentosa, obesity, polydactyly, hypogonadism, and intellectual disability. * **Bassen-Kornzweig Disease (Abetalipoproteinemia):** This is an **AR** condition involving a deficiency of microsomal triglyceride transfer protein (MTP), leading to malabsorption of fat-soluble vitamins (A, E, K) and atypical retinitis pigmentosa. **High-Yield Clinical Pearls for NEET-PG:** 1. **EOG vs. ERG:** In Best disease, the **Electro-oculogram (EOG) is abnormal** (Arden ratio < 1.5) even in the carrier state, while the **Electro-retinogram (ERG) remains normal**. 2. **Stages:** It progresses from Pre-vitelliform → Vitelliform (egg-yolk) → Pseudohypopyon → Vitelliruptive (scrambled egg) → Atrophic/Cicatricial. 3. **Memory Aid:** Most retinal dystrophies are AR, but **Best disease** and **Doyne Honeycomb dystrophy** are notable AD exceptions.

Question 1

A patient presents with detachment of the retina accompanied by photopsia and floaters. What is the most likely diagnosis?

Accepted Answer

Rhegmatogenous retinal detachment

Answer

Vitreous hemorrhage

Answer

Exudative retinal detachment

Answer

Tractional retinal detachment

Question 2

Which of the following is NOT a risk factor for rhegmatogenous retinal detachment?

Accepted Answer

Diabetes

Answer

Aphakia

Answer

High myopia

Answer

Pseudophakia

Question 3

Trucking of vessels is seen in which of the following disorders?

Accepted Answer

Central retinal artery occlusion

Answer

Central retinal vein occlusion

Answer

Hypertensive retinopathy

Answer

Sickle cell retinopathy

Question 4

Which instrument is used for fundus examination?

Accepted Answer

Fundus Examination

Answer

Examination of the optic disc

Answer

Corneal Examination

Answer

Examination of the Angle of Anterior Chamber

Question 5

Central Retinal artery occlusion is known to be associated with which of the following conditions?

Accepted Answer

Orbital mucomycosis

Answer

Panophthalmitis

Answer

Diabetic Retinopathy

Answer

CMV retinitis

Question 6

The Amsler grid test is primarily used for the diagnosis of which condition?

Accepted Answer

Age-related macular degeneration

Answer

Retinitis pigmentosa

Answer

Optic atrophy

Answer

Choroiditis

Question 7

Which of the following is not a feature of hypertensive retinopathy?

Accepted Answer

Neovascularization

Answer

Silver wiring of arterioles

Answer

Bonnet sign

Answer

Disc edema

Question 8

All of the following statements are true about Juxtafoveal Retinal Telangiectasias, EXCEPT?

Accepted Answer

Associated with peripheral telangiectasias

Answer

Variant of Coat's disease

Answer

Associated with telangiectasias in the macula

Answer

Associated with structurally abnormal retinal vessels

Question 9

Which of the following is NOT an AR disorder?

Accepted Answer

Butterfly macular dystrophy

Answer

Gyrate atrophy

Answer

Goldmann syndrome

Answer

Bardet-Biedl syndrome

Question 10

Which of the following conditions has autosomal dominant inheritance?

Accepted Answer

Best disease

Answer

Gyrate atrophy

Answer

Laurence Moon Biedl syndrome

Answer

Bassen-Kornzweig disease

Diseases of the Retina — MCQs

Diseases of the Retina — MCQs

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