Diseases of the Retina Practice Questions

Q: Recurrent vitreous hemorrhage in an otherwise healthy young male is caused by:

Eales disease. ***Eales disease*** - This condition is characterized by **recurrent inflammation** and **vasculitis of the peripheral retinal vessels**, which often leads to neovascularization and subsequent vitreous hemorrhage in young, otherwise healthy individuals. - The disease typically affects young adults, particularly males, and is often bilateral, presenting with episodes of **decreased vision** due to vitreous bleeding. *Trauma* - While trauma can cause vitreous hemorrhage, the question specifies **recurrent** hemorrhage in an "otherwise healthy" individual, making it less likely to be the primary cause of repeated, spontaneous bleeds. - Unless there is a history of repeated injuries, trauma usually presents as an isolated event of hemorrhage. *Sickle cell retinopathy* - This condition is associated with **sickle cell disease**, which would make the individual not "otherwise healthy" and typically presents with other systemic symptoms of the disease. - While sickle cell retinopathy can cause vitreous hemorrhage due to **proliferative changes**, it's usually part of a broader systemic illness, which is contradicted by the prompt. *Retinal vein obstruction* - This condition often occurs in **older individuals** with systemic risk factors such as hypertension, diabetes, or glaucoma, making it less likely in an "otherwise healthy young male." - It usually presents with a single, acute event of hemorrhage with associated **retinal edema** and cotton wool spots, rather than recurrent episodes in the absence of predisposing factors.

Q: In the context of ophthalmology, the Amsler grid is primarily used for:

Identifying central vision defects. ***Identifying central vision defects*** - The Amsler grid is specifically designed to detect **distortions** or **scotomas** (blind spots) in the **central visual field**, which is crucial for tasks like reading and recognizing faces. - It is frequently used for monitoring conditions affecting the macula, such as **age-related macular degeneration (AMD)**, where patients might perceive straight lines as wavy or missing. *Evaluating optic disc morphology* - **Optic disc morphology** is typically assessed with an **ophthalmoscope** or by imaging techniques like **optical coherence tomography (OCT)**, which provide detailed views of the optic nerve head. - The Amsler grid does not provide direct visualization or measurement of the optic disc's structure. *Assessing eye alignment issues* - Eye alignment issues, such as **strabismus**, are evaluated using tests like the **cover-uncover test**, **Hirschberg test**, or prism cover test, which assess the position of the eyes relative to each other. - The Amsler grid focuses on the quality of central vision rather than the coordinated movement or alignment of the eyes. *Examining the complete retina* - A comprehensive examination of the retina, especially the periphery, requires a **dilated fundus examination** using an **ophthalmoscope** or specialized retinal imaging devices. - The Amsler grid only tests the central 10 to 20 degrees of the visual field, specifically the macula and paramacular region, not the entire retina.

Q: Which of the following is NOT a feature of iridocyclitis?

Mucopurulent discharge. ***Mucopurulent discharge*** * **Mucopurulent discharge** is a hallmark symptom of bacterial conjunctivitis, indicating an infection of the conjunctiva rather than the iris and ciliary body. * **Iridocyclitis** involves inflammation inside the eye, which does not typically produce external discharge. *Pain* * **Pain** is a common symptom of iridocyclitis, often described as a throbbing ache due to inflammation and ciliary body spasm. * The pain can worsen with eye movement or exposure to bright light (photophobia). *Constricted pupil* * A **constricted pupil** (miosis) is characteristic of acute iridocyclitis, caused by spasm of the pupillary sphincter muscle and inflammation. * This differentiates it from acute angle-closure glaucoma where the pupil may be mid-dilated. *Circum corneal congestion* * **Circumcorneal congestion**, also known as ciliary flush, is an important sign of iridocyclitis, appearing as a deep red or violet ring of injection around the cornea. * This type of redness indicates inflammation of the deeper structures of the eye, such as the iris and ciliary body.

Q: Which of the following is not a true statement regarding the classic findings in retinitis pigmentosa?

Disc edema is part of the classic triad of RP findings. ***Disc edema is part of the classic triad of RP findings*** - This statement is **FALSE** and is therefore the correct answer to this negatively-worded question. - The **classic triad** of findings in **retinitis pigmentosa** includes **peripheral pigmentary retinopathy** (bone-spicule pigmentation), **attenuated retinal vessels**, and **waxy pallor of the optic disc** (optic atrophy). - **Disc edema is NOT part of the classic triad** - its presence would suggest an alternative or co-existing pathology such as papillitis or papilledema. *RP is associated with Cystoid macular edema* - This is a **true** statement - **cystoid macular edema (CME)** is a well-recognized complication of **retinitis pigmentosa** and often contributes to central vision loss in affected individuals, occurring in approximately 10-50% of RP patients. *Argus 2 retinal implant is used as a treatment modality* - This is a **true** statement - the **Argus II retinal prosthesis** is an FDA-approved treatment option for patients with severe to profound **retinitis pigmentosa** who have lost useful vision, providing some restoration of functional vision. *Electrophysiological changes appear early in the disease before the objective signs* - This is a **true** statement - **electrophysiological changes**, particularly abnormalities on the **electroretinogram (ERG)**, are often the **earliest detectable signs** of **retinitis pigmentosa**, appearing even before visible funduscopic changes or significant symptoms develop.

Q: Retinitis pigmentosa is a feature of all except which of the following?

Hallervorden-Spatz disease. ***Hallervorden-Spatz disease*** - Also known as **Pantothenate kinase-associated neurodegeneration (PKAN)**, this disorder primarily causes **extrapyramidal symptoms** such as dystonia and parkinsonism due to iron accumulation in the basal ganglia. - While it is a neurodegenerative disorder affecting the brain, **retinitis pigmentosa** is not a characteristic feature of Hallervorden-Spatz disease. *Refsum's disease* - This is an **autosomal recessive peroxisomal disorder** characterized by the accumulation of **phytanic acid**, which is toxic to various tissues. - **Retinitis pigmentosa** is a classic symptom, often presenting with night blindness and progressive vision loss, along with **ataxia**, **polyneuropathy**, and **ichthyosis**. *NARP* - **NARP (Neuropathy, Ataxia, Retinitis Pigmentosa)** is a rare mitochondrial disorder caused by mutations in the **MT-ATP6 gene**, leading to energy production deficits. - **Retinitis pigmentosa** is a core feature, contributing to visual impairment, alongside **sensory neuropathy**, **ataxia**, and **developmental delay**. *Abetalipoproteinemia* - This is an **autosomal recessive disorder** characterized by the inability to synthesize **apolipoprotein B**, essential for the formation of chylomicrons and VLDL, leading to severe **malabsorption of fat-soluble vitamins** (A, D, E, K). - Prolonged deficiency of **vitamin E** can result in progressive neurological dysfunction, including **ataxia** and **retinitis pigmentosa**, due to oxidative damage to photoreceptors and nervous tissue.

Q: Which of the following is the MOST common complication of degenerative myopia?

It is associated with choroidal neovascularization.. ***It is associated with choroidal neovascularization.*** - **Choroidal neovascularization (CNV)** is the most common cause of significant vision loss in **degenerative myopia**, occurring in up to 10% of patients. - **Myopic CNV** is characterized by the growth of new, abnormal blood vessels from the choroid into the subretinal space, leading to hemorrhage, fluid leakage, and scarring, thus causing **central vision impairment**. *Myopic degeneration can lead to retinal detachment.* - While **retinal detachment** is a known complication of high myopia due to globe elongation and retinal thinning, it is **less common** than choroidal neovascularization as a cause of significant vision loss. - The risk of **rhegmatogenous retinal detachment** in highly myopic eyes is approximately 1-3%, whereas the lifetime risk of myopic CNV is higher. *Formation of lacquer cracks in Bruch's membrane.* - **Lacquer cracks** are breaks in Bruch's membrane that occur in **high myopia** and represent a pathological feature of degenerative myopia. - They can contribute to vision loss, particularly if CNV develops at their site, but lacquer cracks themselves are **not the most common direct cause of significant vision loss**; rather, complications like CNV arising from them are. *Refractive error greater than -6 D (defining criterion).* - This statement defines **high myopia** rather than a complication of degenerative myopia. - While **degenerative myopia** is a form of high myopia, having a refractive error greater than -6 diopters is a **diagnostic criterion**, not a complication.

Q: All of the following may be used to differentiate Central Retinal Venous Occlusion (CRVO) from Ocular Ischemic Syndrome due to Carotid Artery Stenosis, EXCEPT:

Dilated Retinal Vein. ***Dilated Retinal Vein*** - Both **Central Retinal Vein Occlusion (CRVO)** and **Ocular Ischemic Syndrome (OIS)** can present with dilated retinal veins. - In OIS, venodilation occurs due to reduced perfusion pressure, while in CRVO, it's a direct consequence of venous outflow obstruction. *Tortuous Retinal Vein* - **Tortuous retinal veins** are a characteristic finding in **CRVO** due to the increased resistance to blood flow and the resulting venous congestion. - While mild venodilation can occur in **OIS**, marked tortuosity is less typical as the primary pathology is arterial insufficiency, not venous outflow obstruction. *Retinal Artery Pressure* - **Retinal artery pressure** is typically **reduced** in **Ocular Ischemic Syndrome (OIS)** due to severe carotid artery stenosis, reflecting decreased arterial inflow. - In **CRVO**, retinal artery pressure usually remains normal, as the primary issue is venous outflow obstruction, not arterial supply. *Ophthalmodynamometry* - **Ophthalmodynamometry** measures the pressure required to induce pulsations or collapse of the central retinal artery, indirectly assessing **retinal artery perfusion pressure**. - This test would show **reduced pressure** in **Ocular Ischemic Syndrome (OIS)** due to compromised carotid flow, whereas it would typically be normal in patients with **CRVO**.

Q: For a neonate with threshold retinopathy of prematurity, the most appropriate treatment would be:

Photocoagulation. ***Photocoagulation*** - **Laser photocoagulation** is the most effective treatment for **threshold ROP**, as it ablates the avascular retina, preventing the growth of abnormal vessels. - This procedure aims to halt the progression of **retinal neovascularization** and reduce the risk of retinal detachment and vision loss. *Oxygen therapy adjustment* - While careful **oxygen management** is crucial in preventing and managing ROP, simply adjusting oxygen therapy is not a definitive treatment for established **threshold ROP**. - **Oxygen therapy** primarily influences the initial development of the disease rather than treating advanced stages. *Cryotherapy* - **Cryotherapy**, involving freezing of the peripheral avascular retina, was historically used but has largely been replaced by **laser photocoagulation** due to better precision and reduced collateral damage. - While effective, it is less commonly used today for **threshold ROP** compared to laser treatment. *Antioxidants* - **Antioxidants** have been investigated for their potential role in preventing ROP, but there is insufficient evidence to support their use as a primary treatment for **established threshold ROP**. - Their role is more in **prophylaxis** rather than active treatment of advanced disease.

Q: Which of the following statements about retinoblastoma is false?

Females are more affected than males. ***Females are more affected than males*** - Retinoblastoma shows **no significant gender predisposition**, affecting males and females almost equally. - The incidence rate is roughly 1 in 15,000 live births, with a **similar distribution** between sexes. *Autosomal dominant inheritance pattern* - The heritable form of retinoblastoma follows an **autosomal dominant pattern**, meaning one copy of the altered gene in each cell is sufficient to cause the disorder. - This is linked to mutations in the **RB1 gene**, which acts as a tumor suppressor. *Most common intraocular tumor of childhood* - Retinoblastoma is indeed the **most frequent primary malignant intraocular tumor** in children, typically diagnosed before the age of 5. - It accounts for a significant portion of childhood cancers affecting the eye. *Bilateral involvement not rare* - **Bilateral involvement** is observed in approximately **40% of all retinoblastoma cases**, primarily associated with the germline (heritable) form of the disease. - This often presents earlier than unilateral cases due to the presence of the genetic mutation throughout the body.

Question 1

Recurrent vitreous hemorrhage in an otherwise healthy young male is caused by:

Accepted Answer

Eales disease

Answer

Sickle cell retinopathy

Answer

Trauma

Answer

Retinal vein obstruction

Question 2

What is a reverse hypopyon?

Accepted Answer

Collection of emulsified silicone oil in the anterior chamber

Answer

Collection of pus in the vitreous

Answer

Abscess in the orbit

Answer

Seen in corneal ulcer close to being ruptured

Question 3

In the context of ophthalmology, the Amsler grid is primarily used for:

Accepted Answer

Identifying central vision defects

Answer

Evaluating optic disc morphology

Answer

Assessing eye alignment issues

Answer

Examining the complete retina

Question 4

Which of the following is NOT a feature of iridocyclitis?

Accepted Answer

Mucopurulent discharge

Answer

Pain

Answer

Circum corneal congestion

Answer

Constricted pupil

Question 5

Which of the following is not a true statement regarding the classic findings in retinitis pigmentosa?

Accepted Answer

Disc edema is part of the classic triad of RP findings

Answer

Argus 2 retinal implant is used as a treatment modality

Answer

Electrophysiological changes appear early in the disease before the objective signs

Answer

The classic triad includes peripheral pigmentation, attenuated vessels, and optic atrophy. Disc edema is not part of the triad.

Question 6

Retinitis pigmentosa is a feature of all except which of the following?

Accepted Answer

Hallervorden-Spatz disease

Answer

NARP

Answer

Refsum's disease

Answer

Abetalipoproteinemia

Question 7

Which of the following is the MOST common complication of degenerative myopia?

Accepted Answer

It is associated with choroidal neovascularization.

Answer

Formation of lacquer cracks in Bruch's membrane.

Answer

Myopic degeneration can lead to retinal detachment.

Answer

Refractive error greater than -6 D (defining criterion).

Question 8

All of the following may be used to differentiate Central Retinal Venous Occlusion (CRVO) from Ocular Ischemic Syndrome due to Carotid Artery Stenosis, EXCEPT:

Accepted Answer

Dilated Retinal Vein

Answer

Tortuous Retinal Vein

Answer

Retinal Artery Pressure

Answer

Ophthalmodynamometry

Question 9

For a neonate with threshold retinopathy of prematurity, the most appropriate treatment would be:

Accepted Answer

Photocoagulation

Answer

Antioxidants

Answer

Oxygen therapy adjustment

Answer

Cryotherapy

Question 10

Which of the following statements about retinoblastoma is false?

Accepted Answer

Females are more affected than males

Answer

Most common intraocular tumor of childhood

Answer

Autosomal dominant inheritance pattern

Answer

Bilateral involvement not rare

Diseases of the Retina — MCQs

Diseases of the Retina — MCQs

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