Diseases of the Retina — MCQs
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What is the most common cause of anterior uveitis?
What condition is characterized by cherry red spot at the macula with retinal whitening?
Shaffer's sign is seen in ?
Foster's Fuchs spots are specifically associated with which condition?
What is the primary complication associated with Eale's disease?
What does extraretinal fibrovascular proliferation at the ridge indicate?
Hemorrhage in the vitreous humour is caused by all of the following except:
Which ophthalmological investigation is most appropriate for detailed visualization of the fundus at close range?
Large, white keratic precipitates (mutton-fat KPs) are characteristically seen in?
The best investigation for diagnosing Best disease is
Diseases of the Retina Indian Medical PG Practice Questions and MCQs
Question 581: What is the most common cause of anterior uveitis?
- A. CMV
- B. Toxoplasma
- C. Idiopathic (Correct Answer)
- D. Ankylosing spondylitis
Explanation: ***Idiopathic*** - In a significant proportion of cases of **anterior uveitis**, a specific cause cannot be identified, leading to a diagnosis of idiopathic uveitis. - This highlights the multifactorial nature of the condition, where various triggers or underlying predispositions may not always be evident. *CMV* - **Cytomegalovirus (CMV)** typically causes a **posterior uveitis** or **retinitis**, especially in immunocompromised individuals. - While CMV can rarely cause anterior uveitis, it is not the most common cause. *Toxoplasma* - **Toxoplasmosis** is a frequent cause of **posterior uveitis** or **chorioretinitis**, characterized by focal necrotic lesions in the retina. - It is not a common cause of isolated anterior uveitis, although anterior chamber inflammation can occur secondary to posterior disease. *Ankylosing spondylitis* - **Ankylosing spondylitis** is a well-known systemic condition associated with **acute anterior uveitis**. - However, while a significant association exists, it is not the single most common cause when considering all cases of anterior uveitis, many of which remain idiopathic.
Question 582: What condition is characterized by cherry red spot at the macula with retinal whitening?
- A. CRVO
- B. CRAO (Correct Answer)
- C. Diabetic retinopathy
- D. Syphilitic retinopathy
Explanation: ***CRAO*** - **Central retinal artery occlusion (CRAO)** is characterized by **sudden, profound, painless monocular vision loss**. - The classic funduscopic finding is a **cherry-red spot at the macula** with diffuse **retinal whitening** due to ischemia. *CRVO* - **Central retinal vein occlusion (CRVO)** presents with **painless vision loss** but typically shows **hemorrhages**, **dilated tortuous veins**, and **cotton wool spots** on funduscopic exam. - It does not usually cause retinal whitening or a cherry-red spot. *Diabetic retinopathy* - **Diabetic retinopathy** is characterized by **microaneurysms**, **hemorrhages**, **hard exudates**, and **cotton wool spots**, and can lead to neovascularization. - It does not present with acute retinal whitening or a cherry-red spot in the macula. *Syphilitic retinopathy* - **Syphilitic retinopathy** can cause a variety of presentations, including **retinal vasculitis**, **chorioretinitis**, and **optic neuritis**. - It does not typically manifest as a cherry-red spot with diffuse retinal whitening at the macula.
Question 583: Shaffer's sign is seen in ?
- A. Acute angle-closure glaucoma
- B. Diabetic retinopathy
- C. Age-related macular degeneration
- D. Retinal detachment (Correct Answer)
Explanation: ***Retinal detachment*** - **Shaffer's sign** refers to the presence of **pigment cells** (tobacco dust) in the **anterior vitreous**, indicating a retinal break or detachment. - This sign is due to the release of retinal pigment epithelium cells into the vitreous following a tear in the retina. *Acute angle-closure glaucoma* - This condition is characterized by a **sudden increase in intraocular pressure** due to blocked fluid outflow, causing pain, redness, and blurred vision. - It does not involve pigment cells in the vitreous, but rather changes in the **anterior chamber angle**. *Diabetic retinopathy* - This is a microvascular complication of diabetes, leading to damage to the blood vessels in the retina, causing **hemorrhages**, **exudates**, and **neovascularization**. - It does not typically present with free pigment in the vitreous as a primary diagnostic sign. *Age-related macular degeneration* - This condition affects the **macula**, often causing distorted vision and central vision loss, and is characterized by drusen and atrophy. - While it can involve retinal changes, it does not classically present with pigment cells in the vitreous as a diagnostic indicator.
Question 584: Foster's Fuchs spots are specifically associated with which condition?
- A. Myopia (Correct Answer)
- B. Astigmatism
- C. Hypermetropia
- D. Presbyopia
Explanation: ***Myopia*** - **Foster's-Fuchs spots** are a pathognomonic finding in **pathologic myopia**, characterized by subretinal neovascularization and hemorrhage at the macula. - This condition is associated with high degrees of **myopia** (nearsightedness), leading to thinning and stretching of the retina and choroid. - The spots represent **pigmented scars** from resolved choroidal neovascular membrane hemorrhages. *Hypermetropia* - **Hypermetropia** (farsightedness) does not typically lead to Foster's-Fuchs spots; these spots are specific to the degenerative changes seen in high myopia. - Ocular complications in hypermetropia are different and may include **angle-closure glaucoma** or **accommodative esotropia**. *Astigmatism* - **Astigmatism** is an optical defect where the eye fails to focus light equally on the entire retina, causing blurred vision at any distance. - It is not associated with the development of **Foster's-Fuchs spots**, which are a specific macular degeneration seen in myopia. *Presbyopia* - **Presbyopia** is the age-related loss of accommodation due to decreased lens elasticity. - It is a physiological change and is not associated with **Foster's-Fuchs spots** or the structural changes seen in pathologic myopia.
Question 585: What is the primary complication associated with Eale's disease?
- A. Retinal hemorrhage
- B. Vitreous hemorrhage (Correct Answer)
- C. Conjunctival hemorrhage
- D. Choroidal hemorrhage
Explanation: ***Vitreous hemorrhage*** - **Vitreous hemorrhage** is a common and often visually debilitating complication of Eale's disease, resulting from the rupture of fragile new vessels. - The proliferative stage of Eale's disease involves the development of **neovascularization** on the retina, which can bleed into the vitreous humor. *Retinal hemorrhage* - While **retinal hemorrhages** can occur in Eale's disease, they are often precursors to or components of vitreous hemorrhage, not the primary, most significant complication. - Retinal hemorrhages alone may cause less severe vision loss compared to the extensive obscuration by vitreous bleeding. *Conjunctival hemorrhage* - **Conjunctival hemorrhage** involves bleeding in the superficial layers of the eye and is not typically associated with the underlying vasculitis of Eale's disease. - This is a benign condition and not a primary complication of a retinal vascular disorder. *Choroidal hemorrhage* - **Choroidal hemorrhage** occurs beneath the retina and is usually associated with trauma, surgery, or degenerative conditions like age-related macular degeneration, not Eale's disease. - Eale's disease primarily affects the **retinal vasculature**, leading to bleeding internally into the vitreous.
Question 586: What does extraretinal fibrovascular proliferation at the ridge indicate?
- A. Normal retina
- B. Stage II Retinopathy of Prematurity
- C. Stage III Retinopathy of Prematurity (Correct Answer)
- D. Stage I Retinopathy of Prematurity
Explanation: ***Stage III Retinopathy of Prematurity*** - Extraretinal fibrovascular proliferation at the ridge is the defining characteristic of **Stage III Retinopathy of Prematurity (ROP)**. - This stage signifies significant **neovascularization** extending into the vitreous, increasing the risk of **retinal detachment**. *Normal retina* - A normal retina does not exhibit **fibrovascular proliferation** or a distinct ridge, as its vascularization is fully developed and confined to the retinal plane. - Absence of any abnormal vascular growth or demarcation line indicates a healthy, mature retinal structure. *Stage II Retinopathy of Prematurity* - Stage II ROP is characterized by a **ridge** that is elevated and appears three-dimensional, but it **lacks extraretinal fibrovascular proliferation**. - This stage represents progression from Stage I, where the demarcation line becomes a prominent ridge, but without new vessel formation outside the retina. *Stage I Retinopathy of Prematurity* - Stage I ROP is characterized by a thin, flat **demarcation line** distinguishing vascularized from avascular retina, without any significant elevation or fibrovascular proliferation. - This initial stage indicates an arrested phase of retinal vascular development, but without the more severe signs of neovascularization.
Question 587: Hemorrhage in the vitreous humour is caused by all of the following except:
- A. Diabetes mellitus
- B. CRVO
- C. Glaucoma (Correct Answer)
- D. Trauma
Explanation: ***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.
Question 588: Which ophthalmological investigation is most appropriate for detailed visualization of the fundus at close range?
- A. Retinoscopy
- B. Indirect ophthalmoscopy
- C. Direct ophthalmoscopy (Correct Answer)
- D. Oblique illumination test
Explanation: ***Direct ophthalmoscopy*** - This technique allows for a **highly magnified**, upright image of the fundus, making it ideal for **detailed visualization** of the macula and optic disc at close range. - It provides a **small field of view** but excellent resolution for observing subtle changes. *Retinoscopy* - Retinoscopy is primarily used to objectively determine the **refractive error** of the eye, not for detailed fundus visualization. - It assesses how light is reflected from the retina to determine the need for corrective lenses. *Indirect ophthalmoscopy* - While it provides a **wider field of view** and a stereoscopic image, it offers **less magnification** and thus less detail compared to direct ophthalmoscopy. - It is often used for evaluating the peripheral retina and in cases where direct ophthalmoscopy is difficult. *Oblique illumination test* - This test is used to examine the **anterior segment of the eye**, such as the cornea, anterior chamber, and lens. - It involves shining a light at an angle and observing structures, not for visualizing the fundus.
Question 589: Large, white keratic precipitates (mutton-fat KPs) are characteristically seen in?
- A. Hemorrhagic uveitis
- B. Old healed uveitis
- C. Granulomatous uveitis (Correct Answer)
- D. Acute anterior uveitis
Explanation: ***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.
Question 590: The best investigation for diagnosing Best disease is
- A. Electrooculogram (EOG) (Correct Answer)
- B. Nerve conduction study (Electroneurogram)
- C. Electroretinogram (ERG)
- D. Electroencephalogram (EEG)
Explanation: ***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.
Practice by Chapter
Retinal Anatomy and Physiology
Practice Questions
Age-Related Macular Degeneration
Practice Questions
Diabetic Retinopathy
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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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