Diseases of the Retina Practice Questions

Q: Hemorrhage in the vitreous humour is caused by all of the following except:

Glaucoma. ***Glaucoma*** - **Glaucoma** is primarily characterized by optic nerve damage due to elevated intraocular pressure, leading to **visual field loss**. - While it can lead to vision impairment, it does not typically cause **vitreous hemorrhage** directly, as it doesn't involve the proliferation of fragile blood vessels. *Diabetes mellitus* - **Diabetic retinopathy** is a leading cause of vitreous hemorrhage, especially in its proliferative form, due to the growth of **fragile new blood vessels** (neovascularization) that can bleed into the vitreous. - These new vessels are prone to rupture, leading to sudden vision loss from vitreous bleeding. *CRVO* - **Central Retinal Vein Occlusion (CRVO)** often leads to **retinal ischemia** and the release of **angiogenic factors** (e.g., VEGF), which can cause **neovascularization** on the retina or iris. - These newly formed, fragile vessels can rupture and bleed into the vitreous cavity. *Trauma* - **Ocular trauma**, such as a direct blow to the eye or a penetrating injury, can directly rupture retinal or choroidal blood vessels, leading to a **vitreous hemorrhage**. - This can range from mild bleeding to extensive hemorrhage, depending on the severity and nature of the injury.

Q: Large, white keratic precipitates (mutton-fat KPs) are characteristically seen in?

Granulomatous uveitis. ***Granulomatous uveitis*** - **Mutton-fat keratic precipitates (KPs)** are large, greasy-appearing white deposits on the corneal endothelium, characteristic of **granulomatous inflammation**. - These KPs are composed of macrophages and epithelioid cells, reflecting a **chronic, cell-mediated immune response** seen in granulomatous conditions. *Hemorrhagic uveitis* - This condition involves significant **intraocular bleeding**, which would manifest as hyphema or vitreous hemorrhage, not mutton-fat KPs. - While inflammation may be present, the defining feature is blood, which obscures vision differently than KPs. *Old healed uveitis* - After uveitis heals, KP morphology can change, often appearing smaller, more pigmented, or forming distinct patterns such as **Arlt's triangle**, but not typically actively large, white mutton-fat KPs. - Healed KPs often reflect a less active or resolved inflammatory process, unlike fresh mutton-fat KPs. *Acute anterior uveitis* - This typically presents with smaller, finer, and more numerous **non-granulomatous KPs** (sometimes called "stellate KPs"), in contrast to the large, greasy mutton-fat KPs. - The inflammation is usually acute and less focally organized compared to granulomatous forms.

Q: The best investigation for diagnosing Best disease is

Electrooculogram (EOG). ***Electrooculogram (EOG)*** - **Best disease** (Best vitelliform macular dystrophy) is a genetic disorder affecting the retinal pigment epithelium (RPE), leading to abnormal **light-induced changes in EOG potentials**. - A **significantly reduced or absent Arden ratio** (ratio of light peak to dark trough) on the **electrooculogram (EOG)** is pathognomonic for Best disease, even in early stages when vision may be unaffected. *Nerve conduction study (Electroneurogram)* - A **nerve conduction study** measures the speed and strength of electrical signals as they travel through peripheral nerves. - This test is used for diagnosing conditions affecting **peripheral nerves**, such as neuropathies, and has no relevance to retinal disorders. *Electroretinogram (ERG)* - An **electroretinogram (ERG)** measures the electrical responses of the **photoreceptors and inner retinal cells** to light stimulation. - While ERG is useful in diagnosing various retinal disorders, it usually shows a **normal or nearly normal result in Best disease**, as the primary defect is in the RPE and not the photoreceptors themselves early in the disease course. *Electroencephalogram (EEG)* - An **electroencephalogram (EEG)** records the electrical activity of the **brain**. - It is primarily used to diagnose conditions like **epilepsy, sleep disorders**, and other neurological conditions affecting brain function, and has no utility in diagnosing retinal diseases.

Q: A young man presented with night blindness and tubular vision. On examination, the findings include an intraocular pressure of 18 mm, a normal anterior segment, and fundus examination reveals waxy pallor of the disc, attenuation of arterioles, and bony corpuscles resembling spicules of pigmentation in the midperipheral retina. Perimetry testing shows a ring scotoma with subnormal electroretinography. What is your most likely diagnosis?

Pigmented retinal dystrophy. ***Pigmented retinal dystrophy*** - **Night blindness**, **tubular vision** (due to **ring scotoma**), **waxy pallor of the optic disc**, **arteriolar attenuation**, and **bony spicule** retinal pigmentation are classic signs of **retinitis pigmentosa**, a form of pigmented retinal dystrophy. - **Subnormal electroretinography (ERG)** confirms widespread retinal dysfunction, particularly in photoreceptors. *Primary angle-closure glaucoma* - Characterized by **elevated intraocular pressure** (IOP) and optic nerve damage, often presenting with acute pain, redness, and blurred vision. - The presented IOP of 18 mmHg is normal, and the fundus findings do not correspond to typical glaucomatous changes. *Retinal lattice degeneration* - Involves **thinning of the peripheral retina** with a characteristic lattice-like appearance, which predisposes to retinal tears and detachment. - It does not present with **night blindness**, **pigmentary changes**, or **tubular vision**. *Retinal paving stone degeneration* - Consists of small, round, **hyperpigmented or depigmented lesions** in the far peripheral retina, typically benign and asymptomatic. - It is not associated with **night blindness**, **visual field constriction**, or the severe fundus changes described.

Q: Which of the following is not a feature in diabetic retinopathy on fundus examination?

Arteriolar dilatation. ***Arteriolar dilatation*** - **Arteriolar dilatation** is NOT a feature of diabetic retinopathy; instead, **arteriolar narrowing** or normal caliber arterioles are typically observed. - The vascular changes in diabetic retinopathy predominantly affect the **venous system** (venular dilatation, venous beading, venous loops) and **capillaries** (microaneurysm formation). - Diabetic retinopathy is characterized by **microvascular damage, increased permeability, and ischemia**, not primary arteriolar dilatation. *Microaneurysms* - **Microaneurysms** are the **earliest clinically detectable sign** of diabetic retinopathy, appearing as small red dots on fundus examination. - They result from **pericyte loss** and weakening of capillary walls, leading to localized outpouchings that may leak fluid and lipid exudates. *Retinal hemorrhages* - **Retinal hemorrhages** are common in diabetic retinopathy, including **dot-and-blot hemorrhages** (deep retinal layers) and **flame-shaped hemorrhages** (superficial nerve fiber layer). - They occur due to **rupture of weakened microaneurysms** and breakdown of the blood-retinal barrier from chronic hyperglycemia-induced endothelial damage. *Neovascularisation* - **Neovascularization** is the hallmark of **proliferative diabetic retinopathy** (PDR), involving growth of abnormal new vessels on the retina (NVE) or optic disc (NVD). - These fragile vessels lack normal structural support and are prone to **vitreous hemorrhage** and **tractional retinal detachment**, the major vision-threatening complications of PDR.

Q: A 25-year-old male presents with a history of sudden, painless loss of vision in one eye for the past two weeks, with no history of trauma. On examination, the anterior segment is normal, but there is no fundal glow. Which one of the following is the most likely cause?

Vitreous haemorrhage. ***Vitreous haemorrhage*** - Sudden, **painless loss of vision** and absence of **fundal glow** are classic signs of vitreous haemorrhage, as blood obscures the light path to the retina. - This condition can occur spontaneously due to vitreous detachment, proliferative diabetic retinopathy, or retinal tears, leading to **blood accumulation** in the **vitreous cavity**. *Optic atrophy* - **Optic atrophy** involves pallor of the optic disc due to nerve fiber loss, leading to gradual, often chronic, vision loss, which does **not typically present as sudden blindness**. - The fundal glow is usually preserved, though vision is impaired, unlike in vitreous haemorrhage where light is blocked. *Developmental cataract* - A **developmental cataract** would cause gradual blurring of vision or present as reduced acuity from birth or childhood, not sudden vision loss in an adult. - While it can obstruct the fundal glow in severe cases, the onset and presentation (sudden, painless) do not align with cataract. *Acute attack of angle closure glaucoma* - An **acute attack of angle-closure glaucoma** presents with sudden, severe eye pain, headache, fixed mid-dilated pupil, and often **halos around lights**, which are not reported here. - While vision loss is rapid, the overwhelming symptoms are pain and red eye, and the fundal glow is typically present, though the view may be hazy due to **corneal edema**.

Q: All of the following are true about the incidence of retinoblastoma except:

More common in African children than Caucasian children. ***More common in African children than Caucasian children*** - This statement is **false**, as retinoblastoma incidence shows **no significant racial predilection**. The reported incidence rates are globally consistent across different ethnic groups. - While healthcare access and outcomes may vary, the inherent genetic predisposition and occurrence rate are similar worldwide, independent of race. *Is the most common intraocular tumour of childhood* - This is a **true** statement; retinoblastoma is indeed the most frequently diagnosed primary **intraocular malignancy** in children. - It accounts for a significant proportion of childhood eye cancers, often presenting before the age of five. *No sex predisposition* - This is a **true** statement; studies consistently show that the incidence of retinoblastoma is **equal between male and female children**. - There is no statistically significant difference in the occurrence of this cancer based on sex. *Occurs in 1 in 14000-34000 live births* - This is a **true** statement; the worldwide incidence of retinoblastoma is estimated to be approximately **1 in 14,000 to 1 in 34,000 live births**. - This relatively low but consistent incidence makes it a rare but significant childhood cancer.

Q: Bulls-eye retinopathy is seen in toxicity of:

Chloroquine. ***Chloroquine*** - **Bulls-eye maculopathy** is a classic and severe manifestation of retinal toxicity associated with **chloroquine** and **hydroxychloroquine** use. - This pattern involves central macular damage with a surrounding ring of preserved photoreceptors, affecting **visual acuity** and **color vision**. *Quinine* - Quinine toxicity primarily affects the **optic nerve** and **retinal vessels**, leading to **vasoconstriction** and **ischemia**, which can cause **optic neuropathy** and **sudden vision loss**. - It does not typically cause the characteristic bulls-eye maculopathy pattern. *Tobacco* - **Tobacco amblyopia** is a form of **toxic optic neuropathy** associated with chronic tobacco use, particularly smoking or chewing. - It is characterized by **progressive, painless vision loss**, often with **central or centrocecal scotomas**, and typically affects the **optic nerve** rather than the macula in a bulls-eye pattern. *Ethanol* - **Ethanol** (alcohol abuse) can lead to **nutritional optic neuropathy**, especially when combined with poor diet and vitamin deficiencies (e.g., **B vitamins**). - This condition affects the **optic nerve** and causes **gradual vision loss** and **central scotomas**, but not the specific bulls-eye retinopathy seen with chloroquine.

Question 1

Hemorrhage in the vitreous humour is caused by all of the following except:

Accepted Answer

Glaucoma

Answer

Diabetes mellitus

Answer

CRVO

Answer

Trauma

Question 2

Large, white keratic precipitates (mutton-fat KPs) are characteristically seen in?

Accepted Answer

Granulomatous uveitis

Answer

Hemorrhagic uveitis

Answer

Old healed uveitis

Answer

Acute anterior uveitis

Question 3

The characteristic finding in chloroquine retinopathy is

Accepted Answer

Bull's eye maculopathy

Answer

Retinopathy that resolves immediately after stopping the drug

Answer

Primarily CNS involvement rather than retinal

Answer

Vision loss that is usually reversible

Question 4

The best investigation for diagnosing Best disease is

Accepted Answer

Electrooculogram (EOG)

Answer

Nerve conduction study (Electroneurogram)

Answer

Electroretinogram (ERG)

Answer

Electroencephalogram (EEG)

Question 5

A young man presented with night blindness and tubular vision. On examination, the findings include an intraocular pressure of 18 mm, a normal anterior segment, and fundus examination reveals waxy pallor of the disc, attenuation of arterioles, and bony corpuscles resembling spicules of pigmentation in the midperipheral retina. Perimetry testing shows a ring scotoma with subnormal electroretinography. What is your most likely diagnosis?

Accepted Answer

Pigmented retinal dystrophy

Answer

Primary angle-closure glaucoma

Answer

Retinal lattice degeneration

Answer

Retinal paving stone degeneration

Question 6

Which of the following is not a feature in diabetic retinopathy on fundus examination?

Accepted Answer

Arteriolar dilatation

Answer

Microaneurysms

Answer

Retinal hemorrhages

Answer

Neovascularisation

Question 7

A 25-year-old male presents with a history of sudden, painless loss of vision in one eye for the past two weeks, with no history of trauma. On examination, the anterior segment is normal, but there is no fundal glow. Which one of the following is the most likely cause?

Accepted Answer

Vitreous haemorrhage

Answer

Optic atrophy

Answer

Acute attack of angle closure glaucoma

Answer

Developmental cataract

Question 8

Which of the following treatments is not suitable for advanced proliferative diabetic retinopathy with extensive vitreoretinal fibrosis and tractional retinal detachment?

Accepted Answer

Photocoagulation

Answer

Removal of epiretinal membrane

Answer

Vitrectomy

Answer

Reattachment of detached or torn retina

Question 9

All of the following are true about the incidence of retinoblastoma except:

Accepted Answer

More common in African children than Caucasian children

Answer

Is the most common intraocular tumour of childhood

Answer

No sex predisposition

Answer

Occurs in 1 in 14000-34000 live births

Question 10

Bulls-eye retinopathy is seen in toxicity of:

Accepted Answer

Chloroquine

Answer

Quinine

Answer

Tobacco

Answer

Ethanol

Diseases of the Retina — MCQs

Diseases of the Retina — MCQs

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