Diseases of the Retina — MCQs

Diseases of the Retina Indian Medical PG Practice Questions and MCQs

Question 501: A 30-year-old female presents with night blindness and peripheral vision loss. Likely diagnosis?

A. Retinitis pigmentosa (Correct Answer)
B. Macular degeneration
C. Glaucoma
D. Cataract

Explanation: ***Retinitis pigmentosa*** - This condition is characterized by **progressive degeneration of photoreceptor cells**, particularly **rods**, leading to **night blindness (nyctalopia)** and gradual **peripheral vision loss**. - Often leads to a characteristic **'tunnel vision'** due to the progressive loss of the outer visual field. *Macular degeneration* - Primarily affects **central vision**, leading to difficulty with tasks like reading and recognizing faces, rather than night blindness or peripheral loss. - It involves the **degeneration of the macula**, which is responsible for sharp, detailed central vision. *Glaucoma* - Causes gradual **peripheral vision loss** and can lead to **tunnel vision**, but typically does not cause night blindness as its primary symptom. - Results from **damage to the optic nerve**, often due to increased intraocular pressure. *Cataract* - Causes **clouding of the eye's natural lens**, leading to blurry vision, glare, and dulled colors. - It does not typically present with specific night blindness or peripheral vision loss but rather a general decrease in visual acuity.

Question 502: Assertion: Myopia is a risk factor for retinal detachment. Reason: In myopia, the axial length of the eye increases, causing the retina to thin and become more prone to detachment.

A. Both Assertion and Reason are false.
B. Assertion is true, but Reason is false.
C. Both Assertion and Reason are true, and Reason is the correct explanation for Assertion. (Correct Answer)
D. Both Assertion and Reason are true, but Reason is not the correct explanation for Assertion.

Explanation: **Assertion Analysis:** The assertion is **true** – **myopia is a well-established risk factor for retinal detachment**. This association is particularly strong in **high myopia** (>6 diopters), where the risk increases significantly compared to emmetropic eyes. **Reason Analysis:** The reason is **true and provides the correct explanation** for the assertion. In myopia, especially high myopia, the **axial length of the eye increases** due to excessive elongation of the globe. This stretching leads to: - **Thinning of the retina and choroid** – The ocular tissues are stretched over a larger surface area - **Peripheral retinal degeneration** – Including lattice degeneration and retinal holes - **Increased vitreous liquefaction** – Leading to posterior vitreous detachment - **Greater mechanical stress** on the retina These structural changes make the retina more **fragile and susceptible to breaks**, which can progress to **rhegmatogenous retinal detachment**. **Conclusion:** ***Both Assertion and Reason are true, and Reason is the correct explanation for Assertion.*** The increased axial length and subsequent retinal thinning directly explain why myopia increases retinal detachment risk.

Question 503: A patient presents with a central scotoma and metamorphopsia. What is the most likely cause?

A. Retinal detachment
B. Macular degeneration (Correct Answer)
C. Glaucoma
D. Optic neuritis

Explanation: ***Macular degeneration*** - **Central scotoma** and **metamorphopsia** are classic symptoms of macular degeneration, indicating damage to the macula which is responsible for central and detailed vision. - **Metamorphopsia** refers to distorted vision, where straight lines appear wavy, and is a key indicator of macular involvement. *Retinal detachment* - While a significant eye condition, **retinal detachment** typically presents with symptoms like a sudden increase in **floaters**, flashes of light (photopsia), and a "curtain" coming across the field of vision, not primarily central scotoma and metamorphopsia. - It involves the separation of the sensory retina from the underlying retinal pigment epithelium, causing peripheral visual field loss initially, which can progress to central loss if the macula becomes detached. *Glaucoma* - **Glaucoma** is characterized by progressive optic nerve damage, often associated with increased intraocular pressure. - It typically leads to **peripheral vision loss** first, often described as tunnel vision, and usually does not cause metamorphopsia or a central scotoma until very late stages. *Optic neuritis* - **Optic neuritis** involves inflammation of the optic nerve, leading to sudden, often painful, vision loss in one eye and a **central scotoma**. - However, it typically does not cause **metamorphopsia**, which is more specific to macular pathology.

Question 504: A patient presents with superior quadrant vision loss since one week. Patient has Rheumatic Heart Disease (RHD) and is not taking medications. What is the most likely diagnosis?

A. CRAO
B. CRVO
C. BRAO (Correct Answer)
D. BRVO

Explanation: ***BRAO*** - **Branch retinal artery occlusion** (BRAO) presents with **sudden, painless sectoral or quadrant visual field loss** corresponding to the distribution of the occluded arterial branch. - Superior quadrant vision loss indicates **inferior retinal involvement** (visual field is inverted on retina). - **Rheumatic heart disease** not on anticoagulation poses high risk for **cardiac emboli** from valvular vegetations or atrial fibrillation, which preferentially cause **arterial occlusions** (BRAO/CRAO). - Fundoscopy shows **retinal whitening** in the affected area with a clear demarcation line. *BRVO* - **Branch retinal vein occlusion** causes quadrant vision loss but is **NOT typically embolic** in nature. - BRVO is associated with systemic **vascular risk factors** (hypertension, diabetes, hyperlipidemia), not cardiac emboli. - Fundoscopy shows **flame-shaped hemorrhages** and cotton-wool spots in a wedge distribution. *CRAO* - **Central retinal artery occlusion** presents with **complete, sudden painless monocular vision loss** affecting the entire visual field. - Shows classic **"cherry-red spot"** at the fovea due to diffuse retinal ischemia. - Would not present with isolated quadrant vision loss. *CRVO* - **Central retinal vein occlusion** causes **complete monocular vision loss** with "blood and thunder" appearance on fundoscopy. - Presents with diffuse retinal hemorrhages throughout the retina, not isolated to one quadrant.

Question 505: A 40-year-old male experiences flashes of light. Which of the following can likely be the reason?

A. Retinal detachment (Correct Answer)
B. CRAO
C. SAH
D. Branch retinal artery occlusion

Explanation: ***Retinal detachment*** - Flashes of light, or **photopsia**, are a classic symptom of **retinal detachment**, often caused by the retina pulling away from the underlying choroid. - This sensation occurs as the detached retina is mechanically stimulated, sending abnormal signals to the brain that are interpreted as light flashes. *CRAO* - **Central Retinal Artery Occlusion (CRAO)** typically presents with **sudden, painless, severe vision loss** in one eye, not flashes of light. - The primary pathology is a blockage of blood flow to the retina, leading to **ischemia** and vision impairment. *SAH* - **Subarachnoid Hemorrhage (SAH)** is a neurological emergency characterized by **sudden, severe headache** (thunderclap headache), stiff neck, and altered mental status. - While it can cause visual disturbances, these are usually **diplopia** or **visual field defects** due to cranial nerve involvement, not flashes of light related to retinal pathology. *Branch retinal artery occlusion* - **Branch Retinal Artery Occlusion** causes **sudden, painless vision loss** in a specific part of the visual field corresponding to the occluded branch. - Like CRAO, it is an ischemic event and does not typically present with flashes of light; instead, it results in a **scotoma** or partial vision loss.

Question 506: A 60-year-old man presents with sudden loss of vision in one eye. Fundoscopy shows a cherry-red spot. What is the most likely diagnosis?

A. Macular degeneration
B. Retinal detachment
C. Optic neuritis
D. Central retinal artery occlusion (Correct Answer)

Explanation: ***Central retinal artery occlusion*** - **Sudden, painless loss of vision** in one eye, combined with a **cherry-red spot** on fundoscopy, is the classic presentation of a central retinal artery occlusion (CRAO). - The cherry-red spot is caused by retinal edema making the fovea, which is avascular, appear redder against the pale ischemic retina. *Macular degeneration* - This condition typically causes a **gradual loss of central vision** and metamorphopsia, not sudden and complete vision loss. - Fundoscopic findings include **drusen** and pigmentary changes, not a cherry-red spot. *Retinal detachment* - Characterized by symptoms like **flashing lights**, floaters, and a **curtain-like visual field defect**. - Fundoscopy reveals the detached retina, which appears elevated and often wrinkled, not a cherry-red spot. *Optic neuritis* - Presents with **painful loss of vision** and often **color desaturation**. - Fundoscopy may show a swollen optic disc (papillitis) in some cases, but a cherry-red spot is not a feature.

Question 507: A 50-year-old female presents with sudden onset painless vision loss in her left eye. Fundoscopy reveals a pale retina with a cherry-red spot at the fovea. Carotid ultrasound shows significant stenosis. What is the most likely diagnosis?

A. Central retinal artery occlusion (Correct Answer)
B. Retinal detachment
C. Diabetic retinopathy
D. Acute angle-closure glaucoma

Explanation: ***Central retinal artery occlusion*** - The classic triad of **sudden, painless vision loss**, a **pale retina** with a **cherry-red spot** at the fovea, and evidence of **carotid stenosis** strongly indicates central retinal artery occlusion. - The **cherry-red spot** is due to the preserved choroidal circulation visibility through the thin foveola against the ischemic, opaque surrounding retina. *Retinal detachment* - Typically presents with symptoms like **flashes of light (photopsia)**, **floaters**, and a **dark curtain or shadow** in the visual field, which are not described. - Fundoscopy would show a **detached retina**, not a pale retina with a cherry-red spot. *Diabetic retinopathy* - Develops gradually and is characterized by **microaneurysms**, **hemorrhages**, **exudates**, and **neovascularization**, usually in patients with a history of diabetes. - While it can cause vision loss, it does not present with sudden, painless loss and a cherry-red spot. *Acute angle-closure glaucoma* - Characterized by **sudden, painful vision loss**, often accompanied by **redness**, **halos around lights**, and a **fixed, mid-dilated pupil**. - Fundoscopy would show **cupping of the optic disc** and not a pale retina with a cherry-red spot.

Question 508: A 70-year-old man with hypertension and hyperlipidemia has sudden right eye vision loss, described as a 'curtain coming down'. What is the most likely diagnosis?

A. Amaurosis fugax
B. Optic neuritis
C. Retinal detachment (Correct Answer)
D. Glaucoma

Explanation: ***Retinal detachment*** - The **classic "curtain coming down"** description is pathognomonic for retinal detachment, representing the progressive separation of the neurosensory retina from the retinal pigment epithelium. - Presents with **sudden, persistent vision loss** (not transient), often accompanied by **photopsia (flashes)** and **floaters** in the prodromal phase. - Risk factors include advanced age (vitreous degeneration), myopia, previous cataract surgery, and trauma. - This is an **ophthalmologic emergency** requiring urgent surgical intervention to prevent permanent vision loss. *Amaurosis fugax* - Describes **transient monocular vision loss** lasting seconds to minutes with **complete resolution**. - Caused by emboli from carotid atherosclerosis causing temporary retinal ischemia. - While the patient has vascular risk factors, the **persistent nature** of vision loss (described in present tense as "has vision loss") excludes this diagnosis. - Patients typically describe it as a "curtain that came down **and lifted**." *Optic neuritis* - Presents with **subacute, painful vision loss** developing over hours to days. - Associated with **pain on eye movement** and commonly linked to demyelinating diseases like multiple sclerosis. - The sudden "curtain" description and lack of pain make this diagnosis unlikely. *Glaucoma* - Acute angle-closure glaucoma can cause sudden vision loss but presents with **severe eye pain**, **red eye**, **halos around lights**, and a **mid-dilated fixed pupil**. - Chronic open-angle glaucoma causes **gradual peripheral vision loss** over months to years. - The "curtain coming down" description is not characteristic of either glaucoma type.

Question 509: Which of the following is a common cause of floaters in patients with diabetes?

A. Vitreous hemorrhage (Correct Answer)
B. Retinal detachment
C. Cataract
D. Optic neuritis

Explanation: ***Vitreous hemorrhage*** - In diabetic patients, **neovascularization** (abnormal new blood vessel growth) due to **diabetic retinopathy** is fragile and prone to bleeding into the vitreous humor. - This bleeding manifests as **floaters** or a sudden decrease in vision as blood obstructs light transmission. *Retinal detachment* - While floaters can be a symptom of **retinal detachment**, it's more commonly associated with a **curtain-like vision loss** or flashing lights. - Though diabetic retinopathy can lead to **tractional retinal detachment**, vitreous hemorrhage is a more direct and frequent cause of floaters specifically. *Cataract* - Cataracts cause **blurry vision** or **decreased vision** due to clouding of the lens, rather than discrete floaters. - While common in diabetics, cataracts typically do not present with the sensation of moving spots or cobwebs characteristic of floaters. *Optic neuritis* - Optic neuritis involves **inflammation of the optic nerve**, causing sudden **painful vision loss** and diminished color perception. - It does not typically cause floaters, which are visual phenomena originating from opacities within the vitreous.

Question 510: A 60-year-old male presents with sudden vision loss and floaters. Fundus examination reveals retinal hemorrhages and cotton wool spots. What is the likely diagnosis?

A. Hypertensive retinopathy
B. Central retinal vein occlusion (Correct Answer)
C. Diabetic retinopathy
D. Retinitis pigmentosa

Explanation: ***Central retinal vein occlusion*** - **Sudden vision loss**, **floaters**, and characteristic fundus findings of **retinal hemorrhages** and **cotton wool spots** are classic signs of CRVO. - This condition is caused by a blockage in the central retinal vein, leading to blood and fluid leakage into the retina, creating the typical "blood and thunder" appearance. - CRVO is more common in **older patients** (>50 years) with risk factors like hypertension, diabetes, and glaucoma. *Hypertensive retinopathy* - While it can manifest with **retinal hemorrhages** and **cotton wool spots**, hypertensive retinopathy typically presents with additional findings like **arteriolar narrowing**, **arteriovenous nicking**, and sometimes **papilledema** in severe cases. - The sudden profound vision loss with floaters is more characteristic of **vascular occlusion** rather than hypertensive changes. - Hypertensive retinopathy is typically **bilateral** and develops gradually with chronic hypertension. *Diabetic retinopathy* - This condition is a complication of **diabetes mellitus** and usually develops over a long period, causing **gradual rather than sudden** vision loss. - Although it can present with hemorrhages and cotton wool spots, the **sudden onset** and lack of other diabetic retinopathy features (microaneurysms, hard exudates) make it less likely. - Diabetic retinopathy is typically **bilateral** and progressive. *Retinitis pigmentosa* - This is a group of **genetic disorders** characterized by progressive degeneration of the retina, leading to **night blindness** and **peripheral vision loss** over many years. - It does not cause sudden vision loss, floaters, or the specific fundus findings of retinal hemorrhages and cotton wool spots. - Classic findings include **bone spicule pigmentation**, **attenuated retinal vessels**, and **waxy disc pallor**.

Practice by Chapter

Retinal Anatomy and Physiology

Practice Questions

Age-Related Macular Degeneration

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Diabetic Retinopathy

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Retinal Vascular Diseases

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Retinal Detachment

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Hereditary Retinal Dystrophies

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Inflammatory Retinal Diseases

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Retinal Tumors

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Retinopathy of Prematurity

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Retinal Imaging Techniques

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Intravitreal Pharmacotherapy

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Vitreoretinal Surgery

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