Diseases of the Retina Practice Questions

Q: Fluorescein angiography is used to examine -

Retinal vasculature. ***Retinal vasculature*** - **Fluorescein angiography** involves injecting fluorescein dye into a vein and taking rapid photographs of the retina as the dye perfuses, allowing for detailed visualization of the **retinal blood vessels**. - This technique is crucial for diagnosing and monitoring conditions like **diabetic retinopathy**, **macular degeneration**, and **retinal vascular occlusions** by identifying leaks, non-perfusion areas, and abnormal vessel growth. *Ciliary vasculature* - The **ciliary body vasculature** is not directly visualized by standard fluorescein angiography as it is located anterior to the retina within the uveal tract. - While some dye may perfuse the ciliary body, the primary imaging target and diagnostic utility of fluorescein angiography are the **retinal and choroidal circulations**. *Corneal vasculature* - The normal **cornea is avascular**, meaning it does not contain blood vessels. - **Corneal neovascularization** (new vessel growth) can occur due to pathology, but fluorescein angiography is not the primary or most suitable technique for assessing corneal vessels, which are more readily visible with slit-lamp biomicroscopy. *Conjunctival vasculature* - The **conjunctiva** contains numerous small vessels, but these are superficial and can be directly observed with a slit lamp or even the naked eye. - Fluorescein angiography is an invasive procedure with a higher spatial resolution designed for deeper, more intricate vascular networks like those in the retina, making it overkill and inappropriate for routine assessment of the **conjunctival vasculature**.

Q: Which of the following findings is indicative of active anterior uveitis?

Cells in anterior chamber. ***Cells in anterior chamber*** - The presence of **inflammatory cells** (leukocytes) in the anterior chamber, visualized on slit-lamp examination with focused beam, is the **primary and most definitive indicator** of active anterior uveitis. - These cells result from breakdown of the **blood-aqueous barrier**, allowing inflammatory cells to enter the aqueous humor. - **Grading of cells** (0 to 4+) helps assess severity and monitor treatment response, making this the gold standard for diagnosing active inflammation. *Keratic precipitate* - **Keratic precipitates (KPs)** are deposits of inflammatory cells on the corneal endothelium (posterior corneal surface). - **Fresh KPs** can indicate active inflammation, but they represent a secondary finding—cells that have adhered to the endothelium. - **Old or pigmented KPs** indicate past inflammation rather than current activity. - The presence of **free-floating cells in the anterior chamber** is a more direct and reliable indicator of active disease than KPs. *Circumcorneal congestion* - **Ciliary flush** (circumcorneal congestion) indicates ocular inflammation but is **non-specific**. - It can be seen in various conditions including **acute angle-closure glaucoma**, **keratitis**, **scleritis**, and **iridocyclitis**. - While supportive of the diagnosis, it does not confirm active cellular inflammation. *Corneal edema* - **Corneal edema** typically results from elevated **intraocular pressure** or endothelial dysfunction. - While it can be a complication of severe or chronic uveitis (especially with secondary glaucoma), it is **not a direct indicator** of active anterior chamber inflammation. - It represents a secondary effect rather than a primary inflammatory sign.

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

High myopia. ***High myopia*** - **High myopia** is a risk factor for **rhegmatogenous retinal detachment**, which is caused by a retinal break, not by fluid accumulation from a vascular or inflammatory process. - In rhegmatogenous detachment, vitreous fluid passes through the break into the subretinal space, separating the **neurosensory retina** from the **retinal pigment epithelium**. *Toxemia of pregnancy* - **Toxemia of pregnancy** (preeclampsia/eclampsia) can cause **exudative retinal detachment** due to choroidal ischemia and dysfunction of the retinal pigment epithelium, leading to fluid leakage. - The elevated **blood pressure** and systemic vascular changes impair choroidal perfusion, resulting in serous fluid accumulation beneath the retina. *Scleritis* - **Posterior scleritis** can lead to **exudative retinal detachment** by causing inflammation and edema of the choroid and sclera, which in turn compromises the integrity of the retinal pigment epithelium. - The inflammatory process increases vascular permeability, allowing fluid to leak into the subretinal space. *Central serous retinopathy* - **Central serous retinopathy** is a classic example of **exudative retinal detachment**, characterized by serous fluid accumulation under the macula. - This occurs due to dysfunction or a break in the **retinal pigment epithelium**, often associated with stress and corticosteroid use, leading to fluid leakage from the choroid.

Q: Which of the following statements about the c-wave in electroretinogram (ERG) is most accurate?

The 'c' wave is a slow positive wave.. ***The 'c' wave is a slow positive wave.*** - The **c-wave** in an ERG is generated by the **retinal pigment epithelium (RPE)** and is characterized by its **slow, positive deflection**. - It reflects the **hyperpolarization** of the RPE cells in response to light stimulation. *The 'c' wave is a negative wave.* - This statement is incorrect because the **c-wave** is consistently observed as a **positive deflection** in the ERG tracing. - A negative wave like the **a-wave** is generated by photoreceptor hyperpolarization, which is a different component. *The 'b' wave arises primarily from photoreceptors.* - The **b-wave** primarily arises from the **Müller cells** and **bipolar cells**, not directly from photoreceptors. - Photoreceptor activity is primarily reflected in the **a-wave**. *The 'a' wave is a positive wave.* - The **a-wave** is a **negative deflection** in the ERG, representing the **hyperpolarization of photoreceptors** in response to light. - It is the earliest component of the ERG waveform.

Q: The earliest change noticed in hypertensive retinopathy is:

Arteriolar spasm. ***Arteriolar spasm*** - **Arteriolar spasm** is the **earliest functional change** and is characterized by increased vascular tone in response to elevated blood pressure. - This spasm is a dynamic process and often leads to **narrowing of the retinal arterioles**, which can be observed during fundoscopic examination. *Soft exudate* - **Soft exudates**, also known as **cotton wool spots**, represent areas of **ischemic retinal nerve fiber layer** damage due to obstruction of precapillary arterioles. - These are typically seen in later stages of hypertensive retinopathy, indicating more significant vascular damage and ischemia. *Venospasm* - **Venospasm**, or narrowing of retinal veins, is **not a primary or early finding** in hypertensive retinopathy. - While venous changes like tortuosity can occur, arterial changes dominate the early pathogenesis. *Hard exudate* - **Hard exudates** are yellow-white deposits of **lipid and protein** that leak from damaged capillaries, often indicative of chronic retinal edema and incompetent blood-retinal barrier. - These usually appear in **more advanced stages** of hypertensive retinopathy and are not considered the earliest change.

Q: Parachute lesions are associated with which of the following conditions?

Eale's disease. ***Eale's disease*** - **Eale's disease** is an idiopathic retinal perivasculitis affecting young males, characterized by recurrent vitreous hemorrhages. - In the context of this question (NEET-2013), the term "parachute lesions" refers to the characteristic pattern of hemorrhages seen in Eale's disease. - The disease features retinal periphlebitis, capillary non-perfusion, and neovascularization leading to vitreous hemorrhage. - **Note:** The term "parachute hemorrhages" in broader ophthalmology typically describes preretinal/subhyaloid hemorrhages that settle inferiorly (boat-shaped), more commonly seen in proliferative diabetic retinopathy. *Diabetes* - **Diabetic retinopathy** presents with microaneurysms, dot-blot hemorrhages, hard exudates, cotton-wool spots, and neovascularization. - While proliferative diabetic retinopathy can cause preretinal "parachute-shaped" hemorrhages (boat-shaped hemorrhages that settle inferiorly), this is not the association being tested in this NEET-2013 question. - The specific context of this exam question associates the term with Eale's disease. *Sickle cell anemia* - **Sickle cell retinopathy** features characteristic sea-fan neovascularization in the peripheral retina. - Can cause salmon-patch hemorrhages, black sunburst lesions, and angioid streaks. - While vitreous hemorrhage can occur, "parachute lesions" is not standard terminology for sickle cell retinopathy manifestations. *None of the options* - This option is incorrect because **Eale's disease** is the correct answer according to the NEET-2013 exam key.

Q: Retinal detachment occurs between which layers of the retina?

Neurosensory retina and retinal pigment epithelium. ***Neurosensory retina and retinal pigment epithelium*** * Retinal detachment most commonly occurs when the **neurosensory retina** separates from the underlying **retinal pigment epithelium (RPE)**. * This separation creates a potential space where fluid can accumulate, leading to vision loss as the photoreceptors are no longer supplied by the RPE. * *Retinal pigment epithelium and choroid* * The **RPE** is firmly attached to the underlying **Bruch's membrane** and the **choroid**, making a detachment at this interface extremely rare. * This type of separation would involve a much deeper defect like a choroidal detachment from the sclera. * *Neurosensory retina and choroid* * This option describes two layers that are separated by the **retinal pigment epithelium (RPE)**, so a direct detachment between them is anatomically incorrect. * The RPE acts as a crucial barrier and functional unit between the neurosensory retina and the choroid. * *None of the options* * This is incorrect as the primary site of retinal detachment is clearly defined anatomically. * The separation between the neurosensory retina and the RPE is the hallmark of most retinal detachments.

Q: What is the primary goal in retinal detachment surgery?

Drainage of subretinal fluid. ***Drainage of subretinal fluid*** - The primary goal in retinal detachment surgery is to reattach the retina by draining the **subretinal fluid** that separates the neural retina from the underlying retinal pigment epithelium (RPE). - This fluid accumulation is what causes the retina to detach, so its removal is crucial for successful reattachment. *Removal of vitreous* - While a **vitrectomy** (removal of vitreous) is often performed in some types of retinal detachment surgery (e.g., rhegmatogenous or tractional detachments), it is a *means* to an end, not the primary goal itself. - The purpose of vitrectomy is often to relieve **vitreous traction** on the retina or to clear media opacities, allowing better access to the underlying retina for repair. *To relieve traction on the retina* - Relieving **traction on the retina** is an important *component* of many retinal detachment surgeries, especially in **tractional retinal detachments** or when vitreous traction exacerbates a rhegmatogenous detachment. - However, the ultimate aim of relieving traction is to allow the retina to flatten and reattach, which inherently involves addressing the subretinal fluid that keeps it detached. *Encirclage* - **Encirclage**, or scleral buckling, is a surgical technique used to indent the sclera and choroid, thereby reducing the vitreous traction and bringing the RPE closer to the detached retina. - While it is a common procedure for retinal detachment, it is a *method* of repair rather than the overarching primary goal itself, which remains the reattachment of the retina by resolving the fluid separation.

Q: What condition is characterized by an "umbrella" configuration on fluorescein angiography?

Central serous retinopathy. ***Central serous retinopathy*** - The "umbrella" or "smokestack" configuration on **fluorescein angiography** is a classic finding in central serous retinopathy, indicating leakage of dye creating a mushroom-shaped plume. - This leakage originates from the **retinal pigment epithelium (RPE)** into the subretinal space, causing serous detachment of the neurosensory retina. *Retinitis pigmentosa* - Characterized by **progressive photoreceptor degeneration** and **pigmentary changes** in the retina, often described as "bone-spicule" pigmentation. - Fluorescein angiography in retinitis pigmentosa typically shows **atrophy** and **window defects**, not an umbrella pattern of leakage. *Rhegmatogenous retinal detachment* - Involves a **full-thickness break in the retina** that allows vitreous fluid to pass into the subretinal space, causing the retina to detach. - Fluorescein angiography is generally not used for primary diagnosis and would not show an umbrella pattern, but rather **non-perfusion** or vascular changes in the detached area. *Eale's disease* - A rare **idiopathic obliterative periphlebitis** primarily affecting the retinal veins, leading to recurrent vitreous hemorrhages and retinal neovascularization. - Fluorescein angiography would reveal **vascular sheathing**, **non-perfusion**, and **neovascularization**, which are distinct from the umbrella configuration.

Question 1

Fluorescein angiography is used to examine -

Accepted Answer

Retinal vasculature

Answer

Ciliary vasculature

Answer

Corneal vasculature

Answer

Conjunctival vasculature

Question 2

Which of the following findings is indicative of active anterior uveitis?

Accepted Answer

Cells in anterior chamber

Answer

Circumcorneal congestion

Answer

Keratic precipitate

Answer

Corneal edema

Question 3

Which of the following is not considered an ophthalmological emergency?

Accepted Answer

CRVO

Answer

CRAO

Answer

Acute congestive glaucoma

Answer

Endophthalmitis

Question 4

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

Accepted Answer

High myopia

Answer

Scleritis

Answer

Toxemia of pregnancy

Answer

Central serous retinopathy

Question 5

Which of the following statements about the c-wave in electroretinogram (ERG) is most accurate?

Accepted Answer

The 'c' wave is a slow positive wave.

Answer

The 'c' wave is a negative wave.

Answer

The 'b' wave arises primarily from photoreceptors.

Answer

The 'a' wave is a positive wave.

Question 6

The earliest change noticed in hypertensive retinopathy is:

Accepted Answer

Arteriolar spasm

Answer

Soft exudate

Answer

Venospasm

Answer

Hard exudate

Question 7

Parachute lesions are associated with which of the following conditions?

Accepted Answer

Eale's disease

Answer

Diabetes

Answer

Sickle cell anemia

Answer

None of the options

Question 8

Retinal detachment occurs between which layers of the retina?

Accepted Answer

Neurosensory retina and retinal pigment epithelium

Answer

Retinal pigment epithelium and choroid

Answer

Neurosensory retina and choroid

Answer

None of the options

Question 9

What is the primary goal in retinal detachment surgery?

Accepted Answer

Drainage of subretinal fluid

Answer

Encirclage

Answer

Removal of vitreous

Answer

To relieve traction on the retina

Question 10

What condition is characterized by an "umbrella" configuration on fluorescein angiography?

Accepted Answer

Central serous retinopathy

Answer

Retinitis pigmentosa

Answer

Rhegmatogenous retinal detachment

Answer

Eale's disease

Diseases of the Retina — MCQs

Diseases of the Retina — MCQs

On this page

Practice by Chapter

Want unlimited practice?