Diseases of the Retina Practice Questions

Q: Schaffer's sign is seen in which condition?

Retinal detachment. **Explanation:** **Schaffer’s Sign** (also known as the "Tobacco Dust" sign) refers to the presence of fine, pigment granules in the anterior vitreous. It is a pathognomonic clinical finding for a **Rhegmatogenous Retinal Detachment (RRD)** or a full-thickness retinal tear. **Why it occurs:** When a retinal tear occurs, the Retinal Pigment Epithelium (RPE) cells are released from the subretinal space into the vitreous cavity. On slit-lamp biomicroscopy, these cells appear as brownish-red dust-like particles suspended in the vitreous. Its presence is a high-yield clinical marker, as it strongly suggests a retinal break even if the break is not immediately visible. **Analysis of Incorrect Options:** * **Retinitis Pigmentosa:** Characterized by "bone-spicule" pigmentation in the mid-peripheral retina and arteriolar attenuation, not free-floating vitreous pigment. * **CRVO:** Presents with a "blood and thunder" fundus (diffuse hemorrhages, dilated tortuous veins, and disc edema). * **CRAO:** Characterized by a "cherry-red spot" at the fovea and a pale, edematous retina due to ischemia. **Clinical Pearls for NEET-PG:** * **Tobacco Dust Sign:** Always associated with RPE cell release (Retinal tear/detachment). * **Weiss Ring:** A ring-shaped opacity indicating a Posterior Vitreous Detachment (PVD), which often precedes Schaffer's sign. * **Management:** A patient with new-onset flashes (photopsia), floaters, and a positive Schaffer’s sign requires urgent surgical intervention (e.g., Scleral buckling or Vitrectomy) to prevent permanent vision loss.

Q: What is the earliest feature of Diabetic Retinopathy?

Microaneurysms. **Explanation:** **Microaneurysms** are the hallmark and the **earliest clinically detectable sign** of Diabetic Retinopathy (DR). Pathologically, they represent focal saccular outpouchings of the retinal capillaries. This occurs due to the loss of **pericytes** (which provide structural support to capillary walls) and the weakening of the basement membrane. On fundoscopy, they appear as tiny, round, red dots, typically located in the inner nuclear layer of the retina. On Fluorescein Angiography (FFA), they appear as "pinpoint leaks." **Analysis of Incorrect Options:** * **Cotton wool spots:** These represent focal areas of retinal ischemia in the nerve fiber layer (axoplasmic stasis). They are a feature of Pre-Proliferative Diabetic Retinopathy (PPDR), appearing much later than microaneurysms. * **Dot-and-blot hemorrhages:** These occur when microaneurysms or capillaries rupture within the deeper layers of the retina. While common in Non-Proliferative DR (NPDR), they typically follow the formation of microaneurysms. * **Hard exudates:** These are yellowish deposits of lipids and lipoproteins in the outer plexiform layer, resulting from chronic vascular leakage. They indicate "leakage" rather than the initial vascular structural change. **High-Yield Clinical Pearls for NEET-PG:** * **Earliest Pathological Change:** Loss of pericytes (Pericyte:Endothelial cell ratio drops from 1:1 to 1:0). * **Earliest Clinical Sign:** Microaneurysms. * **First Sign on FFA:** Microaneurysms (seen as hyperfluorescent spots). * **IRMA (Intraretinal Microvascular Abnormalities):** A key feature of Severe NPDR (4-2-1 rule), acting as a precursor to neovascularization. * **Most common cause of vision loss in DR:** Macular Edema.

Q: Which of the following is NOT a sign of diabetic retinopathy?

Choroidal neovascularization. **Explanation:** The correct answer is **D. Choroidal neovascularization (CNV)**. Diabetic Retinopathy (DR) is primarily a **microangiopathy** affecting the retinal precapillary arterioles, capillaries, and venules. The hallmark of DR is retinal ischemia and increased vascular permeability. **Choroidal Neovascularization (CNV)**, however, involves the growth of new vessels from the choroid through Bruch’s membrane into the subretinal space. This is the classic feature of **"Wet" Age-Related Macular Degeneration (ARMD)**, not diabetic retinopathy. **Analysis of Incorrect Options:** * **A. Microaneurysms:** These are the **earliest clinical sign** of DR. They represent focal out-pouchings of retinal capillaries due to pericyte loss. * **B. Cotton wool spots:** Also known as soft exudates, these represent focal areas of retinal ischemia (infarction of the nerve fiber layer) and are a key feature of Pre-proliferative Diabetic Retinopathy (PPDR). * **C. Hard exudates:** These are yellowish deposits of lipids and lipoproteins in the outer plexiform layer, resulting from chronic vascular leakage (increased permeability). **High-Yield Clinical Pearls for NEET-PG:** * **Earliest Pathological Change:** Loss of pericytes and basement membrane thickening. * **Earliest Clinical Sign:** Microaneurysms (seen as tiny red dots). * **Proliferative DR (PDR):** Characterized by **Neovascularization elsewhere (NVE)** or **at the Disc (NVD)**. Note that these are *retinal* new vessels, unlike the *choroidal* vessels in CNV. * **Investigation of Choice:** Optical Coherence Tomography (OCT) for macular edema; Fundus Fluorescein Angiography (FFA) to detect ischemia or neovascularization.

Q: Retinitis pigmentosa inheritance is by which mode?

Autosomal dominant. **Explanation:** Retinitis Pigmentosa (RP) is a genetically heterogeneous group of rod-cone dystrophies. While it exhibits multiple patterns of inheritance, **Autosomal Dominant (AD)** is the correct answer in the context of most standard examinations when asked for a single mode, as it represents the most common inheritance pattern in many clinical cohorts and generally carries the best visual prognosis. * **Why Autosomal Dominant is correct:** It is the most frequent mode of inheritance. The most common gene mutation associated with AD-RP is the **Rhodopsin (RHO) gene**. Patients with AD-RP typically have a later onset and a slower rate of progression compared to other forms. * **Why others are incorrect:** * **Autosomal Recessive (AR):** This is also very common (especially in consanguineous populations) and often presents with intermediate severity. * **X-linked Recessive (XLR):** This is the **most severe form**, characterized by early-onset legal blindness (by age 30-40). It is caused primarily by mutations in the *RPGR* gene. * **Digenic Inheritance:** This is a rare form involving mutations in two different genes (e.g., *ROM1* and *Peripherin/RDS*) simultaneously. **High-Yield Clinical Pearls for NEET-PG:** * **Classic Triad:** Bony spicule pigmentation (perivascular), Arteriolar attenuation (narrowing), and Waxy pallor of the optic disc. * **Earliest Symptom:** Nyctalopia (Night blindness) due to rod dysfunction. * **Earliest Sign:** Scanty pigmentary changes in the mid-periphery. * **Gold Standard Investigation:** Electroretinogram (ERG) – shows a "subnormal" or "extinguished" (flat) scotopic response early in the disease. * **Associated Conditions:** Usher Syndrome (RP + Sensorineural hearing loss) and Laurence-Moon-Biedl Syndrome (RP + Obesity + Polydactyly + Hypogonadism + Intellectual disability).

Q: Retinitis pigmentosa is a feature of all the following syndromes except?

Lowe's syndrome. **Explanation:** **Retinitis Pigmentosa (RP)** is a group of inherited rod-cone dystrophies characterized by progressive vision loss, night blindness (nyctalopia), and "bone-spicule" pigmentation. While often isolated, it is associated with several systemic syndromes. **1. Why Lowe’s Syndrome is the Correct Answer:** **Lowe’s Syndrome (Oculocerebrorenal syndrome)** is an X-linked recessive disorder characterized by the triad of **congenital cataracts**, mental retardation, and renal tubular dysfunction (Fanconi syndrome). It is notably associated with **glaucoma**, but it does **not** feature Retinitis Pigmentosa. **2. Analysis of Incorrect Options (Syndromes associated with RP):** * **Usher’s Syndrome:** The most common syndromic cause of RP. It involves sensorineural hearing loss and RP. * **Refsum’s Syndrome:** A metabolic disorder (phytanic acid storage disease) presenting with RP, peripheral neuropathy, and cerebellar ataxia. It is high-yield because it is one of the few treatable causes of RP (via diet). * **Hallgren’s Syndrome:** A rare autosomal recessive condition characterized by RP, vestibulocerebellar ataxia, and congenital deafness (similar to Usher’s Type I). **Clinical Pearls for NEET-PG:** * **Classic Triad of RP:** Bone-spicule pigmentation, arteriolar attenuation (narrowing), and waxy pallor of the optic disc. * **Other RP-associated syndromes:** Bassen-Kornzweig (Abetalipoproteinemia), Bardet-Biedl (polydactyly, obesity, hypogonadism), and Kearns-Sayre (CPEO + heart block). * **Lowe’s Syndrome Mnemonic:** Remember the "3 Cs" of Lowe’s: **C**ataract (congenital), **C**ognitive impairment, and **C**ystinosis-like renal issues (Fanconi).

Q: Which of the following is NOT a cause of exudative retinal detachment?

Dysthyroid eye disease. Exudative (Serous) Retinal Detachment (ERD) occurs when fluid accumulates in the subretinal space due to damage to the Blood-Retinal Barrier (BRB) or the Retinal Pigment Epithelium (RPE), without the presence of a retinal break or vitreoretinal traction. **Why Dysthyroid Eye Disease (Graves' Ophthalmopathy) is the correct answer:** Dysthyroid eye disease primarily affects the extraocular muscles and orbital fat through autoimmune inflammation and deposition of glycosaminoglycans [1]. While it can cause proptosis, exposure keratopathy, and compressive optic neuropathy, it **does not** typically involve the subretinal space or cause exudative retinal detachment. **Analysis of Incorrect Options:** * **Scleritis:** Posterior scleritis is a classic cause of ERD. Intense inflammation of the sclera spreads to the choroid, leading to increased vascular permeability and fluid leakage into the subretinal space. * **Toxemia of Pregnancy (Preeclampsia/Eclampsia):** Severe systemic hypertension and vasospasm lead to choroidal ischemia and dysfunction of the RPE, causing bilateral serous retinal detachments in approximately 1% of patients with severe preeclampsia. * **Central Serous Retinopathy (CSR):** CSR is characterized by a localized serous detachment of the neurosensory retina at the macula, caused by idiopathic leakage from the choriocapillaris through a defect in the RPE. **NEET-PG High-Yield Pearls:** * **Most common cause of ERD:** Systemic hypertension/Toxemia. * **Most common intraocular tumor causing ERD:** Malignant Melanoma of the choroid. * **Vogt-Koyanagi-Harada (VKH) Syndrome:** A multisystem autoimmune disease and a frequent "favorite" exam topic for causing bilateral exudative RD. * **Shifting Fluid Sign:** The hallmark clinical sign of exudative RD, where subretinal fluid moves to the most dependent part of the retina with changes in head position.

Q: Sudden loss of vision in a patient with diabetic retinopathy is most commonly due to what condition?

Vitreous hemorrhage. **Explanation:** In the context of Diabetic Retinopathy (DR), the keyword **"sudden"** is the clinical differentiator. **1. Why Vitreous Hemorrhage is correct:** Proliferative Diabetic Retinopathy (PDR) is characterized by **neovascularization** (growth of fragile new blood vessels) due to retinal ischemia. These vessels lack structural integrity and easily rupture, bleeding into the vitreous cavity. This results in a sudden, painless loss of vision or the appearance of "floaters" and "cobwebs." It is the most common cause of acute vision loss in diabetic patients. **2. Why the other options are incorrect:** * **Cataract:** While diabetics are prone to "Snowflake cataracts" or early-onset senile cataracts, the vision loss is **gradual and progressive**, not sudden. * **Glaucoma:** Neovascular glaucoma can occur in PDR, but it usually presents with a painful red eye and gradual visual field loss rather than sudden total loss of vision. * **Papilledema:** This refers to optic disc swelling due to increased intracranial pressure. While it can occur in malignant hypertension (sometimes seen in diabetic renal patients), it is not a primary complication of diabetic retinopathy itself. **Clinical Pearls for NEET-PG:** * **Most common cause of gradual vision loss in DR:** Diabetic Macular Edema (DME). * **Most common cause of sudden vision loss in DR:** Vitreous Hemorrhage. * **Other causes of sudden vision loss in DR:** Tractional Retinal Detachment (TRD) and Central Retinal Vein Occlusion (CRVO). * **Investigation of choice for Vitreous Hemorrhage (when the fundus is not visible):** B-Scan Ultrasonography (to rule out underlying retinal detachment).

Question 1

Schaffer's sign is seen in which condition?

Accepted Answer

Retinal detachment

Answer

Retinitis pigmentosa

Answer

Central retinal vein occlusion (CRVO)

Answer

Central retinal artery occlusion (CRAO)

Question 2

What condition is caused by excessive oxygen concentration in neonates?

Accepted Answer

Retrolental fibroplasias

Answer

Respiratory distress syndrome

Answer

Hyaline membrane disease

Answer

Anaemic retinopathy

Question 3

What is the earliest feature of Diabetic Retinopathy?

Accepted Answer

Microaneurysms

Answer

Cotton wool spots

Answer

Dot-and-blot hemorrhages

Answer

Hard exudates

Question 4

Which of the following is NOT a sign of diabetic retinopathy?

Accepted Answer

Choroidal neovascularization

Answer

Microaneurysms

Answer

Cotton wool spots

Answer

Hard exudates

Question 5

Retinitis pigmentosa inheritance is by which mode?

Accepted Answer

Autosomal dominant

Answer

X linked recessive

Answer

Autosomal recessive

Answer

Digenic inheritance

Question 6

What is the treatment of threshold retinopathy of prematurity?

Accepted Answer

Laser photocoagulation

Answer

Slow reduction in oxygen

Answer

Retinal reattachment

Answer

Antioxidants

Question 7

Retinitis pigmentosa is a feature of all the following syndromes except?

Accepted Answer

Lowe's syndrome

Answer

Refsum's syndrome

Answer

Usher's syndrome

Answer

Hallgren's syndrome

Question 8

Which of the following is NOT a cause of exudative retinal detachment?

Accepted Answer

Dysthyroid eye disease

Answer

Scleritis

Answer

Toxemia of pregnancy

Answer

Central serous retinopathy

Question 9

Sudden loss of vision in a patient with diabetic retinopathy is most commonly due to what condition?

Accepted Answer

Vitreous hemorrhage

Answer

Cataract

Answer

Glaucoma

Answer

Papilledema

Question 10

All of the following are true for acquired cytomegalic inclusion disease except?

Accepted Answer

The infection is acquired from the infected cervix of the mother during sexual intercourse

Answer

It occurs only in immunosuppressed patients

Answer

Typical lesion is acute necrotizing retinitis

Answer

Exudative retinal detachment may occur

Diseases of the Retina — MCQs

Diseases of the Retina — MCQs

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