Diseases of the Retina — MCQs

Diseases of the Retina Indian Medical PG Practice Questions and MCQs

Question 531: All of the following are causes of exudative retinal detachment except:

A. Retinopathy of toxemia of pregnancy
B. Sympathetic ophthalmia
C. Exudative retinopathy of Coats
D. Retinopathy of prematurity (Correct Answer)

Explanation: ***Retinopathy of prematurity*** - This condition primarily causes retinal detachment through **vitreoretinal traction** due to abnormal vessel proliferation and subsequent fibrosis, classifying it as **tractional retinal detachment**, not exudative. - The abnormal vessel growth in the peripheral retina leads to scarring and contracture, pulling the retina away from the underlying RPE. *Retinopathy of toxemia of pregnancy* - This is an **exudative retinal detachment** involving accumulation of fluid beneath the retina due to choroidal ischemia and impaired integrity of the retinal pigment epithelium. - The systemic hypertension and endothelial dysfunction in preeclampsia/eclampsia lead to choroidal vasculopathy and subsequent fluid leakage into the subretinal space. *Exudative retinopathy of Coats* - This condition is characterized by congenital abnormal retinal telangiectatic vessels that leak fluid and lipids, leading to massive **subretinal exudation** and subsequent retinal detachment. - It is a classic example of **exudative retinal detachment** occurring predominantly in young males with yellowish subretinal exudates. *Sympathetic ophthalmia* - This is a rare bilateral granulomatous panuveitis following penetrating ocular trauma that can lead to diffuse **chorioretinal inflammation** and **exudative retinal detachment**. - The autoimmune inflammation causes fluid leakage from choroidal vessels into the subretinal space, similar to Vogt-Koyanagi-Harada syndrome.

Question 532: Which part of the eye is primarily affected by Abetalipoproteinemia?

A. Retinal pigment epithelium
B. Retina (Correct Answer)
C. Choroid
D. Optic nerve

Explanation: ***Retina*** - Abetalipoproteinemia leads to a severe deficiency of **fat-soluble vitamins**, especially **vitamin A** and **vitamin E**, which are crucial for retinal health. - This deficiency causes a progressive **retinopathy**, particularly affecting the photoreceptors, leading to **night blindness** and eventual loss of central vision. *Retinal pigment epithelium* - While the **retinal pigment epithelium (RPE)** supports photoreceptor function, the primary and most significant damage in abetalipoproteinemia directly impacts the photoreceptors of the retina itself. - Although the RPE can be secondarily affected due to photoreceptor degeneration, it is not the initial or primary site of pathology. *Choroid* - The **choroid** is a vascular layer that provides oxygen and nutrients to the outer retina, but it is not directly affected by the vitamin deficiencies in abetalipoproteinemia. - Damage to the choroid is not a characteristic feature of this disease. *Optic nerve* - The **optic nerve** transmits visual information from the retina to the brain, and while severe retinal damage can eventually compromise its function, it is not the primary site of pathology in abetalipoproteinemia. - The initial and most direct impact of the vitamin deficiencies is on the retina.

Question 533: Anterior uveitis earliest lesion ?

A. Aqueous flare (Correct Answer)
B. Keratic precipitates
C. Circumcorneal congestion
D. Blurring of vision

Explanation: ***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.

Question 534: What is a common symptom associated with vitreous hemorrhage?

A. Sudden loss of vision without pain (Correct Answer)
B. Sudden loss of vision with pain
C. Gradual loss of vision with pain
D. Gradual loss of vision without pain

Explanation: ***Sudden loss of vision without pain*** - **Vitreous hemorrhage** often presents as an acute, **painless loss of vision** due to blood obscuring the light path to the retina. - Patients may describe **floaters**, **cobwebs**, or a **reddish tint** to their vision, indicating blood in the vitreous cavity. *Sudden loss of vision with pain* - **Sudden vision loss with pain** is more characteristic of conditions like **acute angle-closure glaucoma** or **optic neuritis**. - Vitreous hemorrhage itself is not typically associated with ocular pain unless there's an underlying painful condition like **neovascular glaucoma**. *Gradual loss of vision with pain* - **Gradual vision loss with pain** is rare and not typical for vitreous hemorrhage. - Painful, gradual vision loss might suggest chronic inflammatory conditions or certain **orbital pathologies**. *Gradual loss of vision without pain* - **Gradual, painless vision loss** is often seen in conditions like **cataracts**, **chronic open-angle glaucoma**, or **diabetic retinopathy without acute hemorrhage**. - Vitreous hemorrhage usually manifests with a more acute onset of symptoms.

Question 535: In which type of retinal detachment are retinal tears most commonly observed?

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

Explanation: ***Rhegmatogenous retinal detachment*** - This type of detachment is characterized by a **full-thickness break or tear** in the neurosensory retina, allowing vitreous fluid to pass into the subretinal space. - The term "rhegma" itself is derived from the Greek word for **tear or rupture**, directly indicating the presence of retinal tears. *Secondary retinal detachment* - This is a broad category that encompasses both exudative and tractional retinal detachments, which do not primarily involve retinal tears. - It refers to any retinal detachment that is not rhegmatogenous, meaning the underlying cause is not a retinal break. *Tractional retinal detachment* - This type occurs when **fibrovascular membranes** on the retinal surface contract, pulling the retina away from the underlying retinal pigment epithelium. - While it can lead to retinal tears in some cases, the primary mechanism is **traction**, not a spontaneous tear. *Exudative retinal detachment* - This is caused by the accumulation of **serous fluid** under the retina due to inflammation, vascular leakage, or tumors, without the presence of retinal breaks. - There is no direct involvement of retinal tears; the detachment is due to **fluid accumulation** from compromised retinal or choroidal vessels.

Question 536: Recurrent non-granulomatous uveitis is seen in:

A. Vogt-Koyanagi-Harada syndrome
B. Posner-Schlossman syndrome (Correct Answer)
C. Tuberculosis
D. Sarcoidosis

Explanation: ***Posner-Schlossman syndrome*** - Also known as **glaucomatocyclitic crisis**, this syndrome is characterized by recurrent attacks of **unilateral acute non-granulomatous anterior uveitis** with significantly **elevated intraocular pressure**. - The inflammation is typically mild and transient, without posterior synechiae or significant vision loss, but the recurrent nature and association with high IOP are key features. *Vogt-Koyanagi-Harada syndrome* - This is a **granulomatous panuveitis** associated with neurological, auditory, and dermatological manifestations, which is distinct from the non-granulomatous and recurrent nature described. - It is an autoimmune disorder that affects melanin-containing tissues, leading to symptoms like **vitiligo**, **poliosis**, and **hearing loss** in addition to the uveitis. *Tuberculosis* - Ocular tuberculosis can cause various forms of uveitis, but it typically presents as a **granulomatous uveitis**, which contradicts the "non-granulomatous" description in the question. - It is often associated with systemic tuberculosis, and diagnosis requires evidence of mycobacterial infection. *Sarcoidosis* - Ocular sarcoidosis commonly manifests as a **granulomatous uveitis**, often with characteristic "mutton-fat" keratic precipitates and possibly **posterior uveitis** or **vasculitis**. - Like tuberculosis, its granulomatous nature distinguishes it from the non-granulomatous presentation in the question.

Question 537: Retinoblastoma can occur bilaterally in what percentage of cases?

A. 15-20%
B. 10-15%
C. 20-25%
D. 25-30% (Correct Answer)

Explanation: ***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.

Question 538: Most common primary intraocular neoplasm in a child is?

A. Metastasis
B. Retinoblastoma (Correct Answer)
C. Basal cell carcinoma
D. Squamous cell carcinoma

Explanation: ***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.

Question 539: 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?

A. Focal laser photocoagulation
B. Pan-retinal photocoagulation (Correct Answer)
C. Grid laser photocoagulation
D. Scleral buckling

Explanation: ***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**.

Question 540: What conditions can the photostress test help differentiate between?

A. Retinal and optic nerve diseases
B. Macular and optic nerve diseases (Correct Answer)
C. Cataract and retinal diseases
D. Vitreous and optic nerve diseases

Explanation: ***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.

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

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Retinal Tumors

Practice Questions

Retinopathy of Prematurity

Practice Questions

Retinal Imaging Techniques

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Intravitreal Pharmacotherapy

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Vitreoretinal Surgery

Practice Questions

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