Diseases of the Retina — MCQs

Diseases of the Retina Indian Medical PG Practice Questions and MCQs

Question 571: Retinitis pigmentosa is characterized by ?

A. Loss of central vision
B. Visual field constriction
C. Tubular vision
D. Loss of peripheral vision (Correct Answer)

Explanation: ***Loss of peripheral vision*** - Retinitis pigmentosa is a group of genetic disorders that cause **progressive degeneration of photoreceptor cells**, primarily rods, which are concentrated in the periphery of the retina. - This degeneration leads to a gradual **loss of peripheral vision**, often beginning with **night blindness** and progressing to tunnel vision. *Loss of central vision* - Loss of central vision is characteristic of conditions affecting the **macula**, such as **age-related macular degeneration** or certain forms of **macular dystrophy**. - While later stages of retinitis pigmentosa can affect central vision, the initial and primary characteristic is loss of peripheral vision. *Tubular vision* - **Tubular vision** is an advanced stage of peripheral vision loss, where the visual field shrinks to a narrow central area, resembling looking through a tube. - While it can be a consequence of retinitis pigmentosa, it is a description of the **extent of visual field constriction** rather than the primary characteristic of the disease itself. *Visual field constriction* - **Visual field constriction** is a general term for any reduction in the extent of the visual field. - While retinitis pigmentosa certainly causes visual field constriction, the term "loss of peripheral vision" is more specific to the initial and dominant pattern of vision loss in this condition.

Question 572: Coloboma, most common site?

A. Superotemporal
B. Inferonasal (Correct Answer)
C. Inferotemporal
D. Superonasal

Explanation: ***Inferonasal*** - This is the **most common site** for coloboma because it corresponds to the location of the **fetal optic fissure** (choroidal fissure) during development. - Coloboma results from the **incomplete closure** of the fetal optic fissure, which normally occurs around the fifth to seventh week of gestation. *Superotemporal* - While coloboma can occur in various locations, the **superotemporal quadrant** is not the typical site. - Colobomas are usually found in areas consistent with the path of the optic fissure. *Inferotemporal* - This location is less common for colobomas compared to the inferonasal region. - The inferotemporal region does not align with the usual embryological fusion line of the optic fissure. *Superonasal* - Colobomas in the **superonasal quadrant** are rare. - This area is typically unaffected because it is not part of the fetal optic fissure's normal closure pathway.

Question 573: What is Eales disease?

A. Recurrent optic neuritis
B. Recurrent periphlebitis retinae (Correct Answer)
C. Recurrent papilloedema
D. None of the options

Explanation: **Recurrent periphlebitis retinae** - **Eales disease** is an idiopathic inflammatory condition characterized by **recurrent periphlebitis retinae**, particularly affecting the peripheral retinal veins. - It can lead to **retinal ischemia**, neovascularization, vitreous hemorrhage, and retinal detachment. *Recurrent optic neuritis* - **Optic neuritis** is inflammation of the optic nerve, typically causing acute vision loss and pain with eye movement. - It is a common manifestation of **multiple sclerosis** but is not the primary definition of Eales disease. *Recurrent papilloedema* - **Papilledema** is swelling of the optic disc due to increased intracranial pressure. - While it can cause visual disturbances, it is a distinct condition and not the defining characteristic of Eales disease. *None of the options* - This option is incorrect because "Recurrent periphlebitis retinae" accurately describes Eales disease.

Question 574: What is the most common complication of pars planitis?

A. Cataract (clouding of the lens) (Correct Answer)
B. Retinal detachment (separation of retina)
C. Cystoid macular edema (swelling of central retina)
D. Glaucoma (increased intraocular pressure)

Explanation: **Cataract (clouding of the lens)** - **Cataract formation** is the most common ocular complication in patients with pars planitis, often due to chronic inflammation or steroid use. - The inflammation can disrupt lens metabolism, leading to **opacification** over time. *Retinal detachment (separation of retina)* - While possible, **retinal detachment** is a less common complication of pars planitis compared to cataract formation. - It can occur in severe cases, often due to vitreous traction on fragile peripheral retina or tears associated with **snowbanking**. *Cystoid macular edema (swelling of central retina)* - **Cystoid macular edema (CME)** is a significant cause of vision loss in pars planitis but is not the most frequent complication overall. - It results from the inflammatory compromise of the blood-retinal barrier, leading to fluid accumulation in the **macula**. *Glaucoma (increased intraocular pressure)* - **Glaucoma** can occur in pars planitis, often secondary to chronic inflammation affecting the **trabecular meshwork** or prolonged steroid use. - However, it is less common than cataracts and CME as a primary complication.

Question 575: What type of deposit is commonly associated with age-related macular degeneration?

A. Iron
B. Drusen (Correct Answer)
C. Lipochrome
D. Hemosiderine

Explanation: ***Drusen*** - **Drusen** are yellow deposits of extracellular material that accumulate beneath the **retinal pigment epithelium (RPE)**. - Their presence is a hallmark sign of **age-related macular degeneration (AMD)** and can lead to vision loss by disrupting retinal function. *Iron* - While iron can accumulate in ocular tissues in conditions like **siderosis bulbi** (due to retained intraocular foreign bodies), it is not a characteristic deposit of macular degeneration. - Ocular iron deposition typically causes different pathologies, such as retinal dysfunction or glaucoma, rather than AMD. *Lipochrome* - **Lipochrome** refers to a class of pigments, including **lipofuscin**, which can accumulate in cells as a byproduct of cellular metabolism and aging. - Although lipofuscin buildup occurs in the RPE with age, **drusen** are the specific, organized extracellular deposits pathognomonic for macular degeneration. *Hemosiderine* - **Hemosiderin** is an iron-storage complex formed from the breakdown of hemoglobin, found in situations of hemorrhage or chronic bleeding. - It is not a typical deposit found in macular degeneration; its presence in the retina usually indicates a history of retinal hemorrhage.

Question 576: Toxoplasma in children causes:

A. Chorioretinitis (Correct Answer)
B. Keratitis
C. Papillitis
D. Conjunctivitis

Explanation: ***Chorioretinitis*** - **Toxoplasmosis** is a significant cause of **chorioretinitis** in children, particularly congenital infections. - Ocular toxoplasmosis often presents with **retinal lesions** that can lead to vision loss. *Conjunctivitis* - **Conjunctivitis** is an inflammation of the conjunctiva, typically caused by bacterial or viral infections. - While it can occur in children, it is not a primary or characteristic manifestation of **Toxoplasma infection**. *Keratitis* - **Keratitis** is an inflammation of the cornea, often caused by bacterial, viral, or fungal infections, or sometimes trauma. - Although eyes are affected by **Toxoplasma**, **keratitis** is not the typical ophthalmic presentation; **chorioretinitis** is. *Papillitis* - **Papillitis** refers to inflammation of the optic disc (optic nerve head). - While **Toxoplasma** can rarely affect the optic nerve, **papillitis** is not the most common or specific ocular manifestation compared to **chorioretinitis**.

Question 577: What is the most common cause of vitreous hemorrhage in diabetic retinopathy?

A. Non-proliferative diabetic retinopathy
B. Proliferative diabetic retinopathy (Correct Answer)
C. Severe non-proliferative diabetic retinopathy
D. Diabetic macular edema

Explanation: ***Proliferative diabetic retinopathy*** - **Neovascularization** is the hallmark of proliferative diabetic retinopathy (PDR), where new, fragile blood vessels grow on the surface of the retina and optic disc. - These delicate vessels can easily rupture and bleed into the vitreous humor, leading to a **vitreous hemorrhage**. *Non-proliferative diabetic retinopathy* - This stage is characterized by **microaneurysms**, hemorrhages, and cotton wool spots, but typically lacks significant neovascularization. - While it involves retinal vascular damage, the absence of **newly formed, fragile vessels** makes vitreous hemorrhage less common. *Severe non-proliferative diabetic retinopathy* - This stage shows extensive microvascular abnormalities, including numerous hemorrhages and venular beading, but generally **still no new vessel formation**. - Without the presence of **fragile neovascular membranes**, the risk of significant vitreous hemorrhage is lower compared to PDR. *Diabetic macular edema* - This condition involves **fluid leakage** from damaged retinal vessels into the macula, causing vision loss. - While it's a common complication of diabetes, it primarily causes **macular swelling** and does not directly lead to vitreous hemorrhage.

Question 578: The 'headlight in fog' appearance is seen in which condition?

A. Syphilis
B. Toxocara
C. Herpes
D. Toxoplasmosis (Correct Answer)

Explanation: ***Toxoplasmosis*** - The "headlight in fog" appearance is a classic description of **chorioretinitis** caused by **congenital toxoplasmosis**. - It refers to an old, healed **retinal scar** (headlight) surrounded by active inflammation and **vitreous haze** (fog). *Syphilis* - Ocular syphilis can cause various presentations, including uveitis, retinitis, and optic neuropathy, but it does **not typically** present with the specific "headlight in fog" appearance. - Ocular lesions are often more diffuse or involve distinct **gummatous lesions**. *Toxocara* - Ocular toxocariasis often presents as a **granuloma** (either peripheral or macular) or as **endophthalmitis**, but not the characteristic "headlight in fog" pattern. - The lesions are usually a result of a direct larval migration and subsequent inflammatory reaction. *Herpes* - Herpes simplex virus (HSV) or varicella-zoster virus (VZV) can cause **acute retinal necrosis** (ARN) or progressive outer retinal necrosis (PORN), presenting with widespread retinal whitening and vascular occlusion. - These conditions have distinct appearances, generally **lacking the central scar** with surrounding active inflammation seen in "headlight in fog."

Question 579: What is the first clinical sign observed in a patient with anterior uveitis?

A. Presence of aqueous flare (Correct Answer)
B. Presence of hypopyon
C. Presence of miosis
D. Presence of keratic precipitates

Explanation: ***Presence of aqueous flare*** - **Aqueous flare** is considered the **earliest clinical sign** of anterior uveitis, representing increased protein content in the anterior chamber due to breakdown of the **blood-aqueous barrier**. - It is detected as a visible "haze" when a **slit lamp beam** passes through the anterior chamber, similar to observing dust particles in a light beam. *Presence of hypopyon* - **Hypopyon** is a more severe sign, indicating a **layer of white blood cells** in the anterior chamber, representing a more advanced inflammatory process. - While it can occur in severe anterior uveitis, it is not typically the **first or earliest** clinical manifestation. *Presence of miosis* - **Miosis** (pupillary constriction) can be present in anterior uveitis due to **iris inflammation** and irritation of the sphincter muscle. - However, it is an indirect sign and typically occurs *after* the initial signs of inflammation in the aqueous humor, such as flare. *Presence of keratic precipitates* - **Keratic precipitates (KPs)** are deposits of inflammatory cells on the **endothelium of the cornea**. - These deposits are a result of sustained inflammation and typically appear *after* the initial inflammatory changes in the aqueous humor, such as flare, have already occurred.

Question 580: Metamorphopsia is seen in?

A. Cataract
B. Glaucoma
C. Anterior uveitis
D. Posterior uveitis (Correct Answer)

Explanation: ***Posterior uveitis*** - **Metamorphopsia**, or the perception of distorted images, can occur in **posterior uveitis** due to inflammation affecting the **retina** or **choroid**, leading to retinal edema or detachment. - Inflammatory processes in the posterior segment can cause disruption of photoreceptor alignment and function, altering the perception of straight lines and object shapes. *Anterior uveitis* - Primarily affects the **iris** and **ciliary body**, causing symptoms like **pain**, **photophobia**, **redness**, and reduced vision due to cellular exudates in the anterior chamber. - While vision can be affected, **metamorphopsia** is not a typical hallmark of anterior uveitis, as the retinal architecture is generally preserved. *Cataract* - Involves **clouding of the eye's natural lens**, leading to blurred vision, glare, and dullness of colors. - It does not cause **metamorphopsia** because the retinal structure and its perception of shapes remain intact; the distortion is primarily visual clarity, not shape. *Glaucoma* - Characterized by **progressive optic nerve damage** and visual field loss, often associated with elevated intraocular pressure. - While it causes vision impairment, typically starting with **peripheral vision loss**, it does not cause **metamorphopsia**, as the retina itself is usually not distorted.

Practice by Chapter

Retinal Anatomy and Physiology

Practice Questions

Age-Related Macular Degeneration

Practice Questions

Diabetic Retinopathy

Practice Questions

Retinal Vascular Diseases

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Retinal Detachment

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Hereditary Retinal Dystrophies

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Inflammatory Retinal Diseases

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Retinal Tumors

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Retinopathy of Prematurity

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Retinal Imaging Techniques

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Intravitreal Pharmacotherapy

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Vitreoretinal Surgery

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