Diseases of the Retina — MCQs

Diseases of the Retina Indian Medical PG Practice Questions and MCQs

Question 91: A patient presents with detachment of the retina accompanied by photopsia and floaters. What is the most likely diagnosis?

A. Vitreous hemorrhage
B. Exudative retinal detachment
C. Rhegmatogenous retinal detachment (Correct Answer)
D. Tractional retinal detachment

Explanation: ### **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.

Question 92: Which of the following is NOT a risk factor for rhegmatogenous retinal detachment?

A. Aphakia
B. High myopia
C. Diabetes (Correct Answer)
D. Pseudophakia

Explanation: **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.

Question 93: Trucking of vessels is seen in which of the following disorders?

A. Central retinal artery occlusion (Correct Answer)
B. Central retinal vein occlusion
C. Hypertensive retinopathy
D. Sickle cell retinopathy

Explanation: **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.

Question 94: Which instrument is used for fundus examination?

A. Examination of the optic disc
B. Fundus Examination (Correct Answer)
C. Corneal Examination
D. Examination of the Angle of Anterior Chamber

Explanation: **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.

Question 95: Central Retinal artery occlusion is known to be associated with which of the following conditions?

A. Panophthalmitis
B. Diabetic Retinopathy
C. CMV retinitis
D. Orbital mucomycosis (Correct Answer)

Explanation: **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.

Question 96: The Amsler grid test is primarily used for the diagnosis of which condition?

A. Retinitis pigmentosa
B. Age-related macular degeneration (Correct Answer)
C. Optic atrophy
D. Choroiditis

Explanation: **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)**.

Question 97: Which of the following is not a feature of hypertensive retinopathy?

A. Silver wiring of arterioles
B. Bonnet sign
C. Disc edema
D. Neovascularization (Correct Answer)

Explanation: **Explanation:** Hypertensive retinopathy is primarily a disease of **arteriolar narrowing and vascular leakage** due to acute or chronic elevations in blood pressure. The hallmark of the condition is vasoconstriction, arteriosclerosis, and increased vascular permeability. **Why Neovascularization is the correct answer:** Neovascularization (the growth of new, fragile blood vessels) is a feature of **ischemic retinopathies**, most notably **Diabetic Retinopathy (PDR)**, Central Retinal Vein Occlusion (CRVO), or Eales disease. In hypertension, while ischemia can occur (leading to cotton wool spots), the primary response is not typically proliferative. Neovascularization is **not** a feature of the Keith-Wagener-Barker or Scheie classifications of hypertensive retinopathy. **Analysis of Incorrect Options:** * **Silver wiring (Option A):** A feature of Grade 3/4 arteriosclerosis. As the vessel wall thickens and hyalinizes, the light reflex occupies the entire width of the blood vessel, making it appear like a silver wire. * **Bonnet sign (Option B):** This is a classic **A-V crossing phenomenon** where there is banking of the vein distal to the arteriovenous crossing. Other signs include Salus sign (deflection of the vein) and Gunn sign (tapering of the vein). * **Disc edema (Option C):** This defines **Grade 4 (Malignant) Hypertensive Retinopathy**. It indicates severe, life-threatening systemic hypertension (hypertensive emergency). **High-Yield Clinical Pearls for NEET-PG:** 1. **Keith-Wagener-Barker Classification:** * Grade 1: Mild generalized arteriolar narrowing. * Grade 2: Focal narrowing and A-V nicking. * Grade 3: Retinal hemorrhages, exudates (Macular star), and cotton wool spots. * Grade 4: Grade 3 + **Papilledema (Disc edema)**. 2. **Copper wiring** occurs before silver wiring (Grade 2/3 arteriosclerosis). 3. The earliest sign of hypertensive retinopathy is **generalized arteriolar vasoconstriction**.

Question 98: All of the following statements are true about Juxtafoveal Retinal Telangiectasias, EXCEPT?

A. Variant of Coat's disease
B. Associated with telangiectasias in the macula
C. Associated with structurally abnormal retinal vessels
D. Associated with peripheral telangiectasias (Correct Answer)

Explanation: **Explanation:** **Juxtafoveal Retinal Telangiectasias (Macular Telangiectasia or MacTel)** refers to a group of rare conditions characterized by ectatic, incompetent, and structurally abnormal retinal capillaries specifically localized in the **macular area**. **Why Option D is the Correct Answer (The Exception):** Macular Telangiectasias are, by definition, confined to the **juxtafoveal region** (the area immediately surrounding the fovea). Unlike conditions like Coat’s disease, which frequently involves the peripheral retina, MacTel **does not involve peripheral telangiectasias**. Therefore, statement D is false and the correct choice for this "Except" question. **Analysis of Other Options:** * **Option A:** Historically, MacTel (specifically Type 1) is considered a **localized variant of Coat’s disease**. It is typically unilateral and involves aneurysmal dilations of the capillary network. * **Option B:** The hallmark of the disease is the presence of **telangiectasias** (dilated, leaky capillaries) within the macula, leading to macular edema or neurodegeneration. * **Option C:** Histopathology confirms that these vessels are **structurally abnormal**, showing endothelial cell degeneration and thickened basement membranes, which leads to a breakdown of the blood-retinal barrier. **High-Yield Clinical Pearls for NEET-PG:** * **Gass and Blodi Classification:** * **Type 1:** Unilateral, congenital, aneurysmal (Variant of Coat's). * **Type 2:** Bilateral, acquired, neurodegenerative (Most common; associated with "right-angled vessels" and crystalline deposits). * **Type 3:** Bilateral, occlusive (Very rare). * **Key Diagnostic Tool:** **Optical Coherence Tomography (OCT)** shows characteristic hyporeflective "cavities" in the inner or outer retina (not always due to edema). * **Fluorescein Angiography (FFA):** Shows early telangiectatic vessels with late leakage in the temporal juxtafoveal area.

Question 99: Which of the following is NOT an AR disorder?

A. Gyrate atrophy
B. Goldmann syndrome
C. Bardet-Biedl syndrome
D. Butterfly macular dystrophy (Correct Answer)

Explanation: **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).

Question 100: Which of the following conditions has autosomal dominant inheritance?

A. Best disease (Correct Answer)
B. Gyrate atrophy
C. Laurence Moon Biedl syndrome
D. Bassen-Kornzweig disease

Explanation: **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.

Practice by Chapter

Retinal Anatomy and Physiology

Practice Questions

Age-Related Macular Degeneration

Practice Questions

Diabetic Retinopathy

Practice Questions

Retinal Vascular Diseases

Practice Questions

Retinal Detachment

Practice Questions

Hereditary Retinal Dystrophies

Practice Questions

Inflammatory Retinal Diseases

Practice Questions

Retinal Tumors

Practice Questions

Retinopathy of Prematurity

Practice Questions

Retinal Imaging Techniques

Practice Questions

Intravitreal Pharmacotherapy

Practice Questions

Vitreoretinal Surgery

Practice Questions

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