Diseases of the Retina — MCQs

Diseases of the Retina Indian Medical PG Practice Questions and MCQs

Question 611: Which of the following is not a true statement regarding the classic findings in retinitis pigmentosa?

A. Disc edema is part of the classic triad of RP findings (Correct Answer)
B. Argus 2 retinal implant is used as a treatment modality
C. Electrophysiological changes appear early in the disease before the objective signs
D. The classic triad includes peripheral pigmentation, attenuated vessels, and optic atrophy. Disc edema is not part of the triad.

Explanation: ***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.

Question 612: Which of the following is the MOST common complication of degenerative myopia?

A. Formation of lacquer cracks in Bruch's membrane.
B. Myopic degeneration can lead to retinal detachment.
C. It is associated with choroidal neovascularization. (Correct Answer)
D. Refractive error greater than -6 D (defining criterion).

Explanation: ***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.

Question 613: Which layer of the retina is known for its radio-resistance?

A. Rods and cones
B. Bipolar cells
C. Ganglion cell layer
D. Retinal pigment epithelium (Correct Answer)

Explanation: ***Retinal pigment epithelium*** - The **retinal pigment epithelium (RPE)** is composed of **post-mitotic cells** that rarely undergo division. Cells that are not actively dividing are generally more **radio-resistant** because radiation primarily targets dividing cells by damaging their DNA. - The RPE's function includes absorbing stray light and maintaining the health of the photoreceptors, and its relative **tolerance to radiation** helps preserve these critical functions even under radiation exposure. *Ganglion cell layer* - The **ganglion cell layer** contains the cell bodies of retinal ganglion cells, which are part of the **central nervous system** and are involved in transmitting visual information. - While essential, these cells are **sensitive to radiation** and damage can lead to loss of vision. *Rods and cones* - **Rods and cones** are the photoreceptor cells responsible for light detection and color vision. - They are highly metabolic and can be **damaged by radiation**, leading to functional impairment and vision loss. *Bipolar cells* - **Bipolar cells** transmit signals from photoreceptors to ganglion cells. - They are neuronal cells that are generally **vulnerable to radiation damage**, particularly at higher doses.

Question 614: All of the following may be used to differentiate Central Retinal Venous Occlusion (CRVO) from Ocular Ischemic Syndrome due to Carotid Artery Stenosis, EXCEPT:

A. Dilated Retinal Vein (Correct Answer)
B. Tortuous Retinal Vein
C. Retinal Artery Pressure
D. Ophthalmodynamometry

Explanation: ***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**.

Question 615: Which of the following statements about retinoblastoma is false?

A. Most common intraocular tumor of childhood
B. Autosomal dominant inheritance pattern
C. Females are more affected than males (Correct Answer)
D. Bilateral involvement not rare

Explanation: ***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 616: For a neonate with threshold retinopathy of prematurity, the most appropriate treatment would be:

A. Photocoagulation (Correct Answer)
B. Antioxidants
C. Oxygen therapy adjustment
D. Cryotherapy

Explanation: ***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.

Question 617: Scleral buckling is used in the treatment of

A. Retinal detachment (Correct Answer)
B. Cataract treatment
C. Inflammation of the sclera
D. Bleeding in the vitreous cavity

Explanation: **Retinal detachment** - **Scleral buckling** is a surgical procedure used to treat **retinal detachment** by indenting the sclera and bringing the choroid and retina closer together to reattach the retina. - This technique helps to seal **retinal breaks** and reduce vitreoretinal traction, preventing further detachment and preserving vision. *Cataract treatment* - **Cataract treatment** primarily involves **phacoemulsification**, where the cloudy lens is removed and replaced with an artificial intraocular lens. - Scleral buckling addresses the retina, not the lens. *Inflammation of the sclera* - **Inflammation of the sclera (scleritis)** is treated with **corticosteroids** and other anti-inflammatory medications. - Scleral buckling is a structural surgical intervention, not an anti-inflammatory treatment. *Bleeding in the vitreous cavity* - **Bleeding in the vitreous cavity (vitreous hemorrhage)** is often managed by observation, sometimes requiring **vitrectomy** if the hemorrhage does not clear spontaneously or if there's an underlying retinal tear. - Scleral buckling does not address vitreous hemorrhage directly but targets the underlying retinal pathology.

Question 618: Sudden loss of vision is seen in all except which of the following?

A. Central retinal artery occlusion
B. Retinal detachment
C. Open angle glaucoma (Correct Answer)
D. Vitreous hemorrhage

Explanation: ***Open angle glaucoma*** - **Open-angle glaucoma** is characterized by a **slow, progressive loss of peripheral vision** over time, often without noticeable symptoms until advanced stages. - The insidious nature of vision loss means it is rarely perceived as a sudden event, making it the exception among the listed conditions. *Central retinal artery occlusion* - This condition typically presents as **sudden, profound, painless monocular vision loss**, often described as a "curtain" coming down over the eye. - It is an **ophthalmic emergency** caused by a blockage in the central retinal artery. *Retinal detachment* - Vision loss from **retinal detachment** often occurs suddenly and can manifest as a **dark curtain or shadow** in the visual field. - Patients may also report flashes of light (photopsia) and floaters prior to the vision loss. *Vitreous hemorrhage* - A **vitreous hemorrhage** causes **sudden, painless vision loss** due to blood accumulating in the vitreous cavity, blocking light transmission to the retina. - Patients often describe symptoms like **sudden onset of many floaters**, cobwebs, or a generalized haziness in their vision.

Question 619: Koeppe nodules are typically found on which part of the eye?

A. Cornea
B. Conjunctiva
C. Iris (Correct Answer)
D. Retina

Explanation: ***Iris*** - **Koeppe nodules** are characteristic inflammatory granulomas found along the **pupillary margin** of the iris. - They are typically seen in **granulomatous uveitis**, particularly in conditions like sarcoidosis or tuberculosis. *Cornea* - The cornea is the transparent front part of the eye that covers the iris, pupil, and anterior chamber. - While corneal changes like **keratic precipitates** can occur in uveitis, **Koeppe nodules** do not develop on the cornea itself. *Conjunctiva* - The conjunctiva is the mucous membrane lining the inner surface of the eyelids and covering the anterior sclera. - Inflammatory conditions of the conjunctiva may present with follicles or papillae, but **Koeppe nodules** are not found here. *Retina* - The retina is the light-sensitive tissue at the back of the eye, responsible for vision. - Retinal involvement in uveitis can lead to vasculitis or macula edema, but **Koeppe nodules** are specific to the iris.

Question 620: Most common mode of inheritance for retinitis pigmentosa is:

A. Autosomal dominant
B. X-linked
C. Autosomal recessive (Correct Answer)
D. Mitochondrial inheritance

Explanation: ***Autosomal recessive*** - Retinitis pigmentosa (RP) demonstrates **genetic heterogeneity** with multiple inheritance patterns. - **Autosomal recessive (AR)** inheritance is frequently cited as the most common pattern in many populations, accounting for approximately **50-60% of inherited cases** in various studies. - In AR inheritance, an individual must inherit **two copies of the mutated gene** (one from each parent) to manifest the disease. - Parents are typically asymptomatic carriers, and there is a **25% recurrence risk** with each pregnancy. *Autosomal dominant* - **Autosomal dominant (AD)** inheritance accounts for approximately **30-40% of familial RP cases**. - Only **one copy of the mutated gene** is sufficient to cause the disease. - AD forms typically show **vertical transmission** through generations and often have a **later onset** with milder phenotype compared to AR forms. - Important genes include **RHO** (rhodopsin) mutations. *X-linked* - **X-linked recessive** inheritance represents approximately **5-15% of RP cases**. - This pattern predominantly affects **males**, while females are usually carriers or show milder manifestations. - X-linked RP tends to be the **most severe form** with earliest onset and rapid progression. - The **RPGR** and **RP2** genes are commonly implicated. *Mitochondrial inheritance* - **Mitochondrial inheritance** is **not a recognized pattern** for classic retinitis pigmentosa. - While mitochondrial diseases can cause retinal degeneration, they present as distinct clinical entities (e.g., **NARP, MELAS, Leber's hereditary optic neuropathy**), not as typical RP. - Mitochondrial disorders show **maternal inheritance** and often involve multiple organ systems beyond the retina. **Note:** The relative frequency of inheritance patterns can vary by geographic population and study methodology. Some sources cite autosomal dominant as most common in certain populations. Additionally, **40-50% of RP cases are simplex** (isolated/sporadic) with no clear family history.

Practice by Chapter

Retinal Anatomy and Physiology

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Age-Related Macular Degeneration

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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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Vitreoretinal Surgery

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