Diseases of the Retina Practice Questions

Q: A patient presents with flashing lights, sudden floaters, and the perception of a curtain falling in front of the eye. Which of the following is the most likely diagnosis?

Rhegmatogenous Retinal Detachment. ### Explanation **Correct Answer: A. Rhegmatogenous Retinal Detachment** The clinical triad of **photopsia** (flashing lights), **floaters** (sudden onset), and a **visual field defect** (described as a "curtain falling") is the classic presentation of **Rhegmatogenous Retinal Detachment (RRD)**. * **Photopsia** occurs due to vitreoretinal traction stimulating the retina. * **Floaters** (often a "Ring of Weiss") result from a posterior vitreous detachment or pigment release (Shafer’s sign/tobacco dusting). * The **"curtain falling"** sensation represents the progressive separation of the neurosensory retina from the retinal pigment epithelium (RPE) by subretinal fluid entering through a retinal break (*Rhegma*). **Why the other options are incorrect:** * **B. Tractional Retinal Detachment:** Usually seen in proliferative diabetic retinopathy. It is characterized by slow, progressive vision loss and typically lacks photopsia or acute floaters because there is no acute retinal break. * **C. Vitreous Hemorrhage:** While it causes sudden floaters (often described as "black streaks" or "cobwebs"), it does not typically cause photopsia or a localized "curtain" unless associated with an underlying detachment. * **D. Eale’s Disease:** An idiopathic peripheral perivasculitis. While it can lead to vitreous hemorrhage or tractional detachment in late stages, the primary presentation is painless, sudden blurring of vision in young males, not the acute triad of RRD. **NEET-PG High-Yield Pearls:** * **Shafer’s Sign:** Presence of pigment cells in the anterior vitreous; it is pathognomonic for a retinal tear. * **Most common site of RRD:** Superotemporal quadrant. * **Surgery of Choice:** Scleral buckling or Pars Plana Vitrectomy (PPV). Pneumatic retinopexy is used for superior breaks. * **Marcus Gunn Pupil (RAPD):** Often present if the detachment is extensive or involves the macula.

Q: Macular involvement is a common finding in which of the following conditions?

Cytomegalovirus (CMV). **Explanation:** **Cytomegalovirus (CMV) Retinitis** is the most common opportunistic ocular infection in patients with AIDS (typically when CD4 counts fall below 50 cells/µL). It is characterized by a necrotizing retinitis that spreads along the retinal vessels. A hallmark of CMV retinitis is its predilection for the posterior pole, frequently involving the **macula** and the optic nerve. This leads to profound, irreversible vision loss if not treated promptly with Ganciclovir or Foscarnet. **Analysis of Options:** * **Toxoplasma (Option A):** While *Toxoplasma gondii* causes retinochoroiditis, it typically presents as a focal "headlight in the fog" lesion. While it can occur at the macula, CMV is statistically more "commonly" associated with extensive posterior pole involvement in the context of systemic immunosuppression. * **Malaria (Option B):** Malarial retinopathy (seen in cerebral malaria) involves retinal whitening, vessel changes, and hemorrhages, but primary macular necrotizing retinitis is not its defining feature. * **Syphilis (Option C):** Known as "The Great Imitator," syphilis can cause various forms of uveitis and placoid chorioretinitis, but it is less common than CMV in modern clinical practice for isolated macular-predominant necrotizing retinitis. **High-Yield Clinical Pearls for NEET-PG:** * **Classic Appearance:** CMV retinitis is often described as **"Pizza-pie"** or **"Cottage cheese and ketchup"** appearance due to the mix of white retinal necrosis and red hemorrhages. * **Brush-fire Border:** The infection typically has a granular, advancing edge. * **Frosted Branch Angiitis:** A severe form of retinal vasculitis that can be seen in CMV. * **Treatment of Choice:** Induction and maintenance with **Intravenous Ganciclovir**; Intravitreal injections are used for immediate sight-threatening (macular) lesions.

Q: Pseudoglioma differs from Retinoblastoma in that pseudoglioma is associated with which of the following?

Decreased intraocular pressure. **Explanation:** The term **Pseudoglioma** refers to a group of non-malignant conditions that mimic the clinical appearance of Retinoblastoma (RB), typically presenting as a white pupillary reflex (leukocoria). **Why Option A is Correct:** The key differentiating factor lies in the pathophysiology of the conditions. **Retinoblastoma** is a rapidly growing tumor that often causes secondary glaucoma (increased IOP) due to the tumor mass pushing the iris-lens diaphragm forward or tumor cells clogging the trabecular meshwork. In contrast, many causes of pseudoglioma, such as **Endophthalmitis** or **Persistent Fetal Vasculature (PFV)**, are associated with ciliary body traction or atrophy, leading to decreased aqueous production and **decreased intraocular pressure (hypotony)**. This often results in a smaller, shrunken eye (phthisis bulbi), whereas RB usually presents in a normal-sized or enlarged eye. **Why Other Options are Incorrect:** * **B. Blurring of vision:** This is a non-specific symptom found in both Retinoblastoma and Pseudoglioma and cannot be used as a differentiating feature. * **C. Enlargement of the optic foramen:** This is a classic radiological sign of **Retinoblastoma** when the tumor spreads extraocularly along the optic nerve. It is not a feature of pseudoglioma. **NEET-PG High-Yield Pearls:** * **Most common cause of Pseudoglioma:** Persistent Fetal Vasculature (PFV/PHPV). * **Calcification:** Present in 90% of Retinoblastoma cases (seen on CT/USG); rare in pseudogliomas (except in Astrocytic Hamartoma). * **Age of presentation:** RB usually presents before age 3; pseudogliomas like Coats' disease often present slightly later (6–8 years). * **Key Pseudoglioma Differentials:** Coats' disease, Retinopathy of Prematurity (ROP), Toxocariasis, and Endophthalmitis.

Q: Cotton wool spots are commonly seen in which of the following conditions?

Hypertension. **Explanation:** **Cotton wool spots (CWS)**, also known as soft exudates, are not true exudates. They represent **focal areas of retinal ischemia** in the nerve fiber layer (NFL). When precapillary arterioles are obstructed, axoplasmic flow within the nerves is interrupted, leading to the accumulation of organelles (mitochondria and debris) that appear as fluffy, white, cloud-like lesions with indistinct margins. **Why Hypertension is the Correct Answer:** In the context of this question, **Hypertension** is a classic and primary cause of CWS. They are a hallmark of **Grade III Hypertensive Retinopathy** (Keith-Wagener-Barker classification). Their presence indicates acute, severe retinal ischemia and is a sign that the systemic blood pressure needs urgent control. **Analysis of Other Options:** * **Diabetes Mellitus:** While CWS are seen in Pre-Proliferative Diabetic Retinopathy (PPDR), they are considered a sign of worsening ischemia but are not as pathognomonic for the acute stage as they are in malignant hypertension. * **HIV:** CWS are the most common finding in **HIV Retinopathy** (non-infectious). However, in a general ophthalmology context, hypertension remains the more classic association for "cotton wool spots" unless the question specifically points toward an immunocompromised state. * **Cytomegalovirus (CMV):** CMV retinitis typically presents with a "pizza-pie" or "cheese and ketchup" appearance (hemorrhage and necrosis). While ischemia occurs, CWS are not the defining feature. **High-Yield Clinical Pearls for NEET-PG:** * **Histology:** On microscopic examination, CWS correspond to **Cytoid bodies** (swollen ends of ruptured axons) in the nerve fiber layer. * **Differential Diagnosis (Mnemonic: SHED):** **S**ystemic Hypertension, **H**IV/Hematological disorders, **E**mboli, **D**iabetes. * **Vanishing Act:** CWS are transient and usually fade within 4–6 weeks as the debris is cleared by macrophages.

Q: Sea-fan retina is a characteristic feature of which condition?

Sickle cell retinopathy. **Explanation:** **Sea-fan retinopathy** is a classic hallmark of **Sickle Cell Retinopathy**, specifically the proliferative stage (Stage 3 of Goldberg’s classification). The underlying mechanism involves chronic peripheral retinal ischemia caused by the sickling of red blood cells in small vessels. This ischemia triggers the release of Vascular Endothelial Growth Factor (VEGF), leading to **neovascularization**. These new vessels grow in a distinctive frond-like pattern that resembles the coral *Gorgonia flabellum* (Sea-fan). It is most commonly seen in HbSC and HbS-Thal genotypes rather than HbSS. **Analysis of Incorrect Options:** * **A. CRAO:** Characterized by a "Cherry Red Spot" at the fovea and a pale, edematous retina due to total arterial infarction. * **B. CRVO:** Presents with a "Blood and Thunder" fundus, showing extensive flame-shaped hemorrhages, dilated tortuous veins, and disc edema. * **D. Chloroquine Retinopathy:** Classically presents with "Bull’s Eye Maculopathy" due to RPE atrophy in a concentric ring around the fovea. **NEET-PG High-Yield Pearls:** * **Goldberg’s Stages of Sickle Cell Retinopathy:** 1. Peripheral arteriolar occlusion (Silver wiring) 2. Arteriolar-venular anastomoses (Hairpin loops) 3. **Sea-fan neovascularization** 4. Vitreous hemorrhage 5. Retinal detachment * **Salmon Patch Hemorrhage:** Pre-retinal/Intra-retinal hemorrhage seen in Sickle cell. * **Black Sunburst:** Peripheral RPE hypertrophy following the resolution of a hemorrhage. * **Treatment of choice for Sea-fans:** Scatter laser photocoagulation to the ischemic peripheral retina.

Question 1

A patient presents with flashing lights, sudden floaters, and the perception of a curtain falling in front of the eye. Which of the following is the most likely diagnosis?

Accepted Answer

Rhegmatogenous Retinal Detachment

Answer

Traditional Retinal Detachment

Answer

Vitreous Hemorrhage

Answer

Eale's disease

Question 2

A cherry red spot at the macula is typically seen in which condition?

Accepted Answer

Central retinal vein occlusion

Answer

Macular infarction

Answer

Niemann-Pick disease

Answer

Commotio retinae

Question 3

Macular involvement is a common finding in which of the following conditions?

Accepted Answer

Cytomegalovirus (CMV)

Answer

Toxoplasma

Answer

Malaria

Answer

Syphilis

Question 4

Pseudoglioma differs from Retinoblastoma in that pseudoglioma is associated with which of the following?

Accepted Answer

Decreased intraocular pressure

Answer

Blurring of vision

Answer

Enlargement of the optic foramen

Answer

All of the above

Question 5

What is the best treatment for a patient with a retinal condition requiring intervention?

Accepted Answer

Three monthly injections of Ranibizumab

Answer

Laser photocoagulation

Answer

Photodynamic therapy

Answer

Observation and follow-up

Question 6

Dot and blot (round) retinal haemorrhages are situated at the level of which layer of the retina?

Accepted Answer

Outer plexiform layer

Answer

Ganglion cell layer

Answer

Nerve fibre layer

Answer

Inner nuclear layer

Question 7

A 75-year-old woman with diabetes mellitus and congestive heart failure has a sudden loss of vision in her left eye. Funduscopic examination shows a cherry-red appearance of the foveola, whereas the remaining retina appears pale. No abnormalities of the right eye are noted. Which of the following is the most likely cause for her sudden unilateral visual loss?

Accepted Answer

Central retinal artery occlusion

Answer

Cytomegalovirus retinitis

Answer

Primary angle-closure glaucoma

Answer

Proliferative retinopathy

Question 8

Degree of diabetic retinopathy depends on which of the following?

Accepted Answer

Duration of diabetes

Answer

Type of diabetes

Answer

Severity of hyperglycemia

Answer

Retinal involvement

Question 9

Cotton wool spots are commonly seen in which of the following conditions?

Accepted Answer

Hypertension

Answer

HIV

Answer

Diabetes Mellitus

Answer

Cytomegalovirus

Question 10

Sea-fan retina is a characteristic feature of which condition?

Accepted Answer

Sickle cell retinopathy

Answer

Central retinal artery occlusion (CRAO)

Answer

Central retinal vein occlusion (CRVO)

Answer

Chloroquine retinopathy

Diseases of the Retina — MCQs

Diseases of the Retina — MCQs

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