Diseases of the Retina — MCQs

Diseases of the Retina Indian Medical PG Practice Questions and MCQs

Question 561: Choroidal neovascularization is most commonly seen in which of the following refractive errors?

A. Myopia (Correct Answer)
B. Hypermetropia
C. Presbyopia
D. Astigmatism

Explanation: ***Myopia*** - High myopia, particularly **pathologic myopia** (>6D or axial length >26mm), is a significant risk factor for **choroidal neovascularization (CNV)** among refractive errors due to the elongation of the eyeball stretching and thinning the choroid and Bruch's membrane. - The mechanical stress and associated **degenerative changes** in the posterior segment can lead to ruptures in Bruch's membrane, facilitating the growth of new, fragile blood vessels from the choroid into the subretinal space. - **Pathologic myopia** is the **second most common cause of CNV overall** (after age-related macular degeneration) and the **most common cause in patients under 50 years**. *Hypermetropia* - Hypermetropia (farsightedness) is associated with a **shorter axial length** of the eye, which generally reduces the risk of the structural changes that predispose to CNV. - While other conditions can cause CNV, hypermetropia itself is **not a risk factor** for its development. *Presbyopia* - Presbyopia is an **age-related loss of accommodation** due to hardening of the lens and weakening of the ciliary muscle, affecting near vision. - It is a refractive change related to the lens's flexibility and **not directly to the structural changes** in the choroid or retina that lead to CNV. *Astigmatism* - Astigmatism is a refractive error where the eye's cornea or lens has **irregular curvature**, causing blurred vision at all distances. - It is a **surface curvature issue** and does not typically involve the deep structural changes in the choroid or retina that are conducive to choroidal neovascularization.

Question 562: Which of the following is NOT a feature of CMV retinitis?

A. Perivasculitis
B. Brush-fire appearance
C. Immunosuppression
D. Cracked mud appearance (Correct Answer)

Explanation: ***Cracked mud appearance*** - **"Cracked mud appearance"** is not a term used to describe CMV retinitis. The classic descriptions include **"pizza pie"**, **"cottage cheese and ketchup"**, and **"brush-fire"** appearances. - CMV retinitis presents with **necrotizing retinitis** with hemorrhages and granular opacification, not a cracked or atrophic pattern. - This option describes a **non-existent finding** in the context of CMV retinitis. *Immunosuppression* - **Immunosuppression**, especially due to **HIV/AIDS** (CD4 count <50 cells/μL), organ transplantation, or chemotherapy, is a **primary risk factor** for CMV retinitis. - It is crucial for the **reactivation** of latent CMV infection, leading to opportunistic disease. - While technically a predisposing condition rather than a "feature" of the disease itself, it is strongly associated with CMV retinitis. *Brush-fire appearance* - The **"brush-fire appearance"** is a classic description of CMV retinitis, referring to the **active leading edge** of the infection with confluent areas of necrosis and hemorrhage spreading across the retina. - This term captures the **fulminant necrotizing retinitis** with yellow-white retinal opacification and hemorrhages. *Perivasculitis* - **Perivasculitis**, or inflammation around the retinal blood vessels, is a **characteristic pathological feature** of CMV retinitis. - It often manifests as **frosted branch angiitis** (white sheathing around retinal vessels), which can be seen in severe cases.

Question 563: Which of the following findings is indicative of active anterior uveitis?

A. Cells in anterior chamber (Correct Answer)
B. Circumcorneal congestion
C. Keratic precipitate
D. Corneal edema

Explanation: ***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.

Question 564: Which of the following statements about the c-wave in electroretinogram (ERG) is most accurate?

A. The 'c' wave is a slow positive wave. (Correct Answer)
B. The 'c' wave is a negative wave.
C. The 'b' wave arises primarily from photoreceptors.
D. The 'a' wave is a positive wave.

Explanation: ***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.

Question 565: Which of the following conditions is NOT diagnosed by fluorescein angiography?

A. Diabetes retinopathy
B. Hypertensive retinopathy (Correct Answer)
C. Central serous retinopathy
D. Choroidal neovascularization

Explanation: ***Hypertensive retinopathy*** - This condition is primarily diagnosed by **clinical fundoscopic examination**, not fluorescein angiography - Diagnosis is based on characteristic clinical findings: **arteriovenous nicking, copper/silver wire arterioles, cotton-wool spots, flame-shaped hemorrhages, and papilledema** in severe cases - **Fluorescein angiography** is rarely needed and only used in research settings or to assess severe complications; it is **not a standard diagnostic tool** for hypertensive retinopathy *Diabetic retinopathy* - **Fluorescein angiography** is extensively used for diagnosing and staging diabetic retinopathy - It helps identify **microaneurysms, capillary non-perfusion areas, macular edema, and neovascularization** - Essential for detecting **proliferative diabetic retinopathy** and planning laser photocoagulation *Central serous retinopathy* - **Fluorescein angiography** shows characteristic **"smokestack" or "inkblot" pattern** of leakage at the RPE level - Demonstrates one or more **leakage points** with progressive pooling of dye in the subretinal space - While **OCT** is now preferred for initial diagnosis, FA remains valuable for identifying leakage sites and guiding treatment *Choroidal neovascularization* - **Fluorescein angiography** is the gold standard for diagnosing **choroidal neovascularization (CNV)** - Shows **early hyperfluorescence with progressive leakage** from abnormal vessels - Critical for determining the **type (classic vs occult), location, and extent** of CNV for treatment planning

Question 566: Birdshot retinopathy is characterized by all except?

A. Common in females
B. Creamy yellow spots
C. HLA-A29 positive
D. Unilateral (Correct Answer)

Explanation: ***Unilateral*** - **Birdshot retinopathy** is characteristically a **bilateral** inflammatory condition affecting both eyes, even if the onset may be asymmetric. - The disease involves widespread inflammation of the **choroid** and **retina**, typically presenting in both eyes simultaneously or sequentially. - Unilateral presentation would be highly atypical and should prompt consideration of alternative diagnoses. *Common in females* - Birdshot retinopathy shows a **clear female predominance**, with approximately **2-3 times more females affected than males** (60-75% of cases). - This demographic trend is a well-established feature of the disease. - However, it does occur in both sexes and is still considered characteristic of the condition. *HLA-A29 positive* - A strong association with the **HLA-A29 allele** is a hallmark of birdshot retinopathy, found in **over 95% of affected individuals**. - This genetic marker is highly specific and often used to support the diagnosis. - HLA-A29 testing is considered part of the diagnostic workup. *Creamy yellow spots* - The presence of characteristic **creamy yellow-white choroidal lesions**, resembling birdshot scatter, is a defining clinical feature. - These lesions are typically located in the **mid-peripheral and posterior fundus**, distributed radially around the optic disc. - The "birdshot" appearance refers to the scattered pattern resembling shotgun pellet distribution.

Question 567: Retinal detachment occurs between which layers of the retina?

A. Retinal pigment epithelium and choroid
B. Neurosensory retina and retinal pigment epithelium (Correct Answer)
C. Neurosensory retina and choroid
D. None of the options

Explanation: ***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.

Question 568: Parachute lesions are associated with which of the following conditions?

A. Eale's disease (Correct Answer)
B. Diabetes
C. Sickle cell anemia
D. None of the options

Explanation: ***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.

Question 569: What is the primary goal in retinal detachment surgery?

A. Encirclage
B. Drainage of subretinal fluid (Correct Answer)
C. Removal of vitreous
D. To relieve traction on the retina

Explanation: ***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.

Question 570: Which of the following is not considered an ophthalmological emergency?

A. CRAO
B. Acute congestive glaucoma
C. CRVO (Correct Answer)
D. Endophthalmitis

Explanation: ***CRVO (Correct Answer)*** - **Central retinal vein occlusion (CRVO)** is considered the **least emergent** among the given options, though it still requires urgent evaluation. - Unlike CRAO, CRVO has a **relatively longer therapeutic window** as vision loss occurs due to venous congestion and edema rather than acute arterial ischemia. - While CRVO can lead to serious complications (macular edema, neovascular glaucoma), intervention within hours rather than minutes is acceptable, making it less urgent than the other listed conditions. - Management includes monitoring for complications and treating underlying vascular risk factors. *CRAO (Incorrect)* - **Central retinal artery occlusion (CRAO)** is a **true ophthalmological emergency** requiring intervention within **90-120 minutes**. - Causes profound, sudden, painless unilateral vision loss due to **acute retinal ischemia**. - Without immediate treatment, permanent retinal cell death and irreversible blindness occur. - Emergency measures include ocular massage, anterior chamber paracentesis, and systemic therapies to restore blood flow. *Acute congestive glaucoma (Incorrect)* - **Acute angle-closure glaucoma** is an emergency due to sudden, severe elevation of intraocular pressure (IOP >40-50 mmHg). - Can cause **irreversible optic nerve damage** within hours if untreated. - Presents with severe eye pain, headache, nausea, blurred vision, halos, fixed mid-dilated pupil, and corneal edema. - Requires immediate IOP reduction with medications and definitive laser peripheral iridotomy. *Endophthalmitis (Incorrect)* - **Endophthalmitis** is a severe intraocular infection (bacterial or fungal) that can rapidly destroy ocular tissues. - Requires **urgent intravitreal antibiotics** (within 6-12 hours) to prevent permanent vision loss or loss of the eye. - Presents with pain, redness, decreased vision, and hypopyon (pus in anterior chamber). - Post-operative endophthalmitis is the most common form, occurring after cataract surgery or penetrating trauma.

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

Practice Questions

Retinal Tumors

Practice Questions

Retinopathy of Prematurity

Practice Questions

Retinal Imaging Techniques

Practice Questions

Intravitreal Pharmacotherapy

Practice Questions

Vitreoretinal Surgery

Practice Questions

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