Diseases of the Retina Practice Questions

Q: Retinoblastoma can occur bilaterally in what percentage of cases?

25-30%. ***25-30%*** - Approximately **25-30%** of retinoblastoma cases are **bilateral**, which is typically associated with the **germline (heritable)** form of the disease. - Patients with bilateral retinoblastoma are at higher risk for **second primary cancers** later in life. *10-15%* - This percentage is too low; **bilateral retinoblastoma** occurs more frequently than this. - A lower incidence of bilateral cases would suggest a stronger predominance of the **sporadic (non-heritable) form**. *15-20%* - This percentage does not accurately reflect the established prevalence of **bilateral retinoblastoma**. - While it's within the range of bilateral occurrences, it underestimates the true frequency. *20-25%* - While closer, this range still slightly underestimates the actual proportion of **bilateral retinoblastoma cases**. - The higher range accounts for cases arising from new germline mutations in addition to inherited ones.

Q: Most common primary intraocular neoplasm in a child is?

Retinoblastoma. ***Retinoblastoma*** - **Retinoblastoma** is the **most common primary intraocular malignancy in children**, typically presenting before the age of 5. - It arises from **immature retinal cells** and can be inherited (germline mutation) or sporadic. *Metastasis* - **Metastasis** to the eye is rare in children and is typically associated with advanced, widespread cancers from other primary sites. - While possible, it is not considered the primary intraocular neoplasm of highest incidence in this age group. *Basal cell carcinoma* - **Basal cell carcinoma** is a **skin cancer** that rarely occurs in children and almost exclusively affects sun-exposed areas like the eyelids, not primarily intraocular structures. - It is an **epithelial tumor** and does not originate from intraocular tissues. *Squamous cell carcinoma* - **Squamous cell carcinoma** is another type of **skin cancer**, more common in older adults with significant UV exposure, and is exceedingly rare as a primary intraocular tumor, especially in children. - Like basal cell carcinoma, it primarily affects the skin, including the eyelids, rather than the internal eye.

Q: Anterior uveitis earliest lesion ?

Aqueous flare. ***Aqueous flare*** - **Aqueous flare** represents the earliest lesion in anterior uveitis due to increased protein content in the anterior chamber, causing light scattering. - This increased protein is a result of **breakdown of the blood-aqueous barrier** and leakage from inflamed ciliary body capillaries. *Keratic precipitates* - **Keratic precipitates (KPs)** are inflammatory cells that adhere to the corneal endothelium, forming later in the disease process. - While characteristic of uveitis, they are not the *earliest* sign of the inflammatory response within the aqueous humor itself. *Circumcorneal congestion* - **Circumcorneal congestion**, also known as ciliary flush, indicates inflammation of the anterior segment of the eye, particularly the ciliary body. - Although an early sign, it is a vascular response and follows the subtle, microscopic changes of protein leakage that constitute aqueous flare. *Blurring of vision* - **Blurring of vision** is a symptom reported by the patient and is a consequence of the inflammatory process (e.g., cell/protein accumulation, corneal edema, iris spasm). - It is not a direct anatomical or physiological lesion but rather a functional impairment resulting from the underlying inflammation.

Q: A diabetic patient presents to you with visual acuity of 6/9 in one eye. Further investigations revealed preretinal hemorrhages with neovascularization at the optic disc. What is the next step in management?

Pan-retinal photocoagulation. ***Pan-retinal photocoagulation*** - The presence of **preretinal hemorrhages** and **neovascularization at the optic disc (NVD)** indicates **high-risk proliferative diabetic retinopathy (PDR)**. - **NVD is a high-risk characteristic** for severe vision loss and requires urgent treatment with **pan-retinal photocoagulation (PRP)**. - PRP aims to ablate ischemic peripheral retina, which reduces the production of **VEGF** and other angiogenic factors that stimulate neovascularization. *Focal laser photocoagulation* - This treatment targets discrete leaking microaneurysms in cases of **clinically significant macular edema (CSME)**, which is not the primary issue here. - It is used for **non-proliferative diabetic retinopathy** with macular involvement, not for neovascularization. *Grid laser photocoagulation* - Grid laser is a type of focal laser used for **diffuse macular edema** where specific leaking microaneurysms cannot be identified. - It is not indicated for **neovascularization** or **preretinal hemorrhages**, which are signs of PDR. *Scleral buckling* - **Scleral buckling** is a surgical procedure primarily used to treat **retinal detachment** by indenting the sclera to relieve vitreoretinal traction. - It is not the initial or primary treatment for **proliferative diabetic retinopathy** or **neovascularization**.

Q: Which chemotherapy agents are commonly used for the treatment of retinoblastoma?

vincristine, carboplatin and etoposide. ***Vincristine, carboplatin and etoposide*** - This combination is a well-established and commonly used **chemotherapy regimen** for the systemic treatment of retinoblastoma, particularly when there is significant intraocular disease or extraocular extension. - **Vincristine** targets microtubules, **carboplatin** is an alkylating agent, and **etoposide** is a topoisomerase inhibitor, working together to achieve a synergistic antineoplastic effect. *Vinblastine, etoposide and bleomycin* - While etoposide is used, **vinblastine** is not a primary agent for retinoblastoma, and **bleomycin** is more commonly associated with germ cell tumors or lymphomas, not retinoblastoma. - This combination lacks the broad spectrum of activity and specific targeting for retinoblastoma that is present in the standard regimen. *Vinblastine, vincristine and etoposide* - Although vincristine and etoposide are used, **vinblastine** is not typically included in the first-line systemic chemotherapy for retinoblastoma. - The absence of a platinum agent like carboplatin would make this regimen less effective for retinoblastoma, which often requires a strong alkylating agent. *Vinblastine, vincristine and cisplatin* - While vincristine is appropriate, **vinblastine** is not a standard component, and **cisplatin** is an alkylating agent but **carboplatin** is generally preferred in retinoblastoma due to its similar efficacy and a more favorable toxicity profile, especially regarding nephrotoxicity. - The use of cisplatin can lead to more significant **renal toxicity** and potentially ototoxicity compared to carboplatin, which is often avoided in a pediatric population when alternatives exist.

Q: What conditions can the photostress test help differentiate between?

Macular and optic nerve diseases. ***Macular and optic nerve diseases*** - The **photostress test** assesses the functional recovery of the macula after exposure to bright light. - Patients with **macular dysfunction** will experience a prolonged recovery time of **visual acuity** (>60 seconds) compared to those with **optic nerve disease** or normal eyes, where recovery is typically faster. *Retinal and optic nerve diseases* - While the photostress test differentiates macular (a part of the retina) from optic nerve disease, "retinal diseases" is too broad, as it includes peripheral retinal conditions not directly assessed by macular function. - **Peripheral retinal diseases** may not significantly impact the photostress recovery time, making this option less precise. *Cataract and retinal diseases* - The photostress test is not primarily designed to differentiate between **cataracts** and **retinal diseases**. - **Cataracts** cause generalized reduced vision but do not typically prolong **photostress recovery** unless a significant **macular pathology** is co-existent. *Vitreous and optic nerve diseases* - **Vitreous opacities** or **hemorrhages** can cause scattered light and reduced vision, but they do not specifically prolong **macular recovery** after photostress in the same way **macular degeneration** does. - The test focuses on **photoreceptor recovery**, which is not directly affected by the vitreous.

Q: What is the typical appearance of a subhyaloid hemorrhage in the eye?

Boat shaped. ***Boat shaped*** - A subhyaloid hemorrhage is located beneath the **hyaloid membrane** (the posterior vitreous cortex), which is attached to the retina. - The collected blood often assumes a **dependent, gravity-influenced shape**, appearing flat on top and curved underneath, resembling a boat. *Crescent shaped* - This shape is not characteristic of a typical subhyaloid hemorrhage; it might be seen in other types of hemorrhages or detachment patterns. - **Crescentic shapes** are more commonly associated with certain types of **retinal detachments** or tears where fluid accumulation takes on a curved boundary. *Round* - While hemorrhages can be round, a subhyaloid hemorrhage typically spreads out due to gravity within the confined space, resulting in a more distinct shape. - A **perfectly round hemorrhage** is less common in the subhyaloid space as blood tends to layer out rather than remain as a sphere. *Flame shaped* - **Flame-shaped hemorrhages** are typically found in the **nerve fiber layer** due to the orientation of nerve fibers. - These hemorrhages are shallower and follow the linear arrangement of nerve fibers, unlike the larger, more globular subhyaloid bleeds.

Q: Purtscher's retinopathy is associated with -

Head trauma. ***Head trauma*** - **Purtscher's retinopathy** is a rare occlusive microvasculopathy characterized by sudden vision loss and specific retinal findings, classically associated with **head or chest trauma**. - The condition occurs due to **fat embolization** and **leukoembolization** with complement activation, leading to occlusion of retinal precapillary arterioles. - Classic findings include **cotton wool spots**, intraretinal hemorrhages, and **Purtscher flecken** (polygonal areas of retinal whitening between the optic disc and macula). - The term "Purtscher's retinopathy" specifically refers to trauma-induced cases, while "Purtscher-like retinopathy" describes similar findings from non-traumatic causes (acute pancreatitis, fat embolism syndrome, amniotic fluid embolism). *Diabetes Mellitus* - **Diabetic retinopathy** is associated with chronic hyperglycemia causing microvascular damage, characterized by microaneurysms, dot-blot hemorrhages, hard exudates, and venous beading. - It involves gradual progressive changes over years, not acute embolic occlusion from trauma. - Advanced stages include **proliferative diabetic retinopathy** with neovascularization and diabetic macular edema. *Wilson's disease* - **Wilson's disease** is an autosomal recessive disorder of copper metabolism affecting the liver, brain, and eyes. - Ocular manifestations include **Kayser-Fleischer rings** (copper deposition in Descemet's membrane) and sunflower cataracts. - It does not cause acute retinal vascular occlusion or the specific findings of Purtscher's retinopathy. *Rheumatoid arthritis* - **Rheumatoid arthritis** is a chronic autoimmune inflammatory disease primarily affecting joints. - Ocular manifestations include **keratoconjunctivitis sicca** (dry eyes), **episcleritis**, **scleritis**, and peripheral ulcerative keratitis. - It is not associated with Purtscher's retinopathy, which is specifically linked to traumatic or embolic events.

Q: Muscae volitantes is seen in?

Vitreous detachment. ***Vitreous detachment*** - **Muscae volitantes** (Latin for "flying flies") is the classical term for **vitreous floaters** - **Posterior vitreous detachment (PVD)** is the **most common cause** of muscae volitantes - PVD occurs due to **vitreous liquefaction** and **vitreoretinal separation**, causing **collagen fibers and cellular debris** to cast shadows on the retina - These floaters are typically described as **spots, cobwebs, or threads** that move with eye movement - PVD is extremely common, particularly **after age 50-60 years**, and in **myopic patients** *Remains of primitive hyaloid vasculature* - **Hyaloid remnants** (such as **Mittendorf's dot** or **Bergmeister's papilla**) are **congenital developmental anomalies** - While these can occasionally be visible as small opacities, they are **not the classical cause** of muscae volitantes - These are typically **stationary** rather than "floating" as the term implies *Vitreous Hemorrhage* - Causes **sudden onset** of numerous floaters, often described as **"shower of red blood cells"** or dense black spots - Associated with **significant vision loss** and requires urgent evaluation - Not the benign, chronic floaters typical of muscae volitantes *Eale's disease* - **Peripheral retinal vasculitis** causing **recurrent vitreous hemorrhages** - Floaters occur secondary to **hemorrhage**, not the primary pathology of muscae volitantes - Presents with **recurrent episodes** and **vision loss**, not isolated benign floaters

Question 1

Retinoblastoma can occur bilaterally in what percentage of cases?

Accepted Answer

25-30%

Answer

15-20%

Answer

10-15%

Answer

20-25%

Question 2

Most common primary intraocular neoplasm in a child is?

Accepted Answer

Retinoblastoma

Answer

Metastasis

Answer

Basal cell carcinoma

Answer

Squamous cell carcinoma

Question 3

Anterior uveitis earliest lesion ?

Accepted Answer

Aqueous flare

Answer

Keratic precipitates

Answer

Circumcorneal congestion

Answer

Blurring of vision

Question 4

A diabetic patient presents to you with visual acuity of 6/9 in one eye. Further investigations revealed preretinal hemorrhages with neovascularization at the optic disc. What is the next step in management?

Accepted Answer

Pan-retinal photocoagulation

Answer

Focal laser photocoagulation

Answer

Grid laser photocoagulation

Answer

Scleral buckling

Question 5

Which chemotherapy agents are commonly used for the treatment of retinoblastoma?

Accepted Answer

vincristine, carboplatin and etoposide

Answer

vinblastine, etoposide and bleomycin

Answer

vinblastine, vincristine and etoposide

Answer

vinblastine, vincristine and cisplatin

Question 6

What is the primary cause of exudative retinal detachment?

Accepted Answer

Inflammation and vascular abnormalities leading to fluid accumulation beneath the retina.

Answer

Traction on the retina causing detachment.

Answer

Retinal tear leading to fluid accumulation.

Answer

Fluid accumulation due to Coats' disease.

Question 7

What conditions can the photostress test help differentiate between?

Accepted Answer

Macular and optic nerve diseases

Answer

Retinal and optic nerve diseases

Answer

Cataract and retinal diseases

Answer

Vitreous and optic nerve diseases

Question 8

What is the typical appearance of a subhyaloid hemorrhage in the eye?

Accepted Answer

Boat shaped

Answer

Crescent shaped

Answer

Round

Answer

Flame shaped

Question 9

Purtscher's retinopathy is associated with -

Accepted Answer

Head trauma

Answer

Diabetes Mellitus

Answer

Wilson's disease

Answer

Rheumatoid arthritis

Question 10

Muscae volitantes is seen in?

Accepted Answer

Vitreous detachment

Answer

Vitreous Hemorrhage

Answer

Remains of primitive hyaloid vasculature

Answer

Eale's disease

Diseases of the Retina — MCQs

Diseases of the Retina — MCQs

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