Diseases of the Retina Practice Questions

Q: Fluorescein dye study is done to detect:

Retinal vascular pathology. ***Retinal vascular pathology*** - **Fluorescein angiography** is a diagnostic procedure using a fluorescent dye to visualize and study blood flow in the **retinal blood vessels**. - It helps detect and characterize various retinal vascular conditions like **diabetic retinopathy**, **retinal vein occlusions**, and **macular edema**. *Assess retinal vascular conditions in babies* - While fluorescein angiography can be performed in babies, it's generally avoided due to the need for sedation and potential risks, making it less routine than for adult retinal conditions. - The primary purpose is broader than just babies; it's used across all age groups where retinal vascular pathology is suspected. *Macular vascular pathology* - **Macular vascular pathology** is a specific type of retinal vascular pathology, but the dye study assesses the entire retinal vasculature, not just the macula. - Focusing solely on the macula would be an incomplete description of the widespread utility of fluorescein angiography. *Posterior segment of eye* - The **posterior segment** includes structures beyond just the retina, such as the choroid and optic nerve. - While fluorescein angiography provides some information about choroidal circulation, its primary and most detailed application is for evaluating the **retinal vasculature**.

Q: Treatment of choice for clinically significant macular edema in a diabetic is?

Intravitreal anti-VEGF injections. ***Intravitreal anti-VEGF injections*** - **Anti-VEGF agents** (e.g., ranibizumab, aflibercept) are the first-line treatment for **clinically significant diabetic macular edema (DME)** as they effectively reduce vascular leakage and improve vision. - They target **vascular endothelial growth factor (VEGF)**, a key mediator of increased vascular permeability and neovascularization in diabetic retinopathy. *Control of Diabetes* - While essential for preventing the **progression of diabetic retinopathy** and overall health, it is not the primary direct treatment for *existing* clinically significant macular edema. - Good glycemic control can reduce the *risk* of developing DME but does not acutely resolve established edema. *Panretinal Photocoagulation* - **Panretinal photocoagulation (PRP)** is primarily used for **proliferative diabetic retinopathy (PDR)** to ablate ischemic retina and reduce neovascularization. - It is not the treatment of choice for macular edema, as it can sometimes worsen macular function and visual acuity due to treatment-induced damage. *Focal Photocoagulation* - **Focal laser photocoagulation** was historically used for DME, targeting discrete leaking microaneurysms. - While effective for specific focal leakage, it has largely been superseded by **anti-VEGF injections** due to their superior efficacy in diffuse edema and better visual outcomes, especially when edema involves the fovea.

Q: First retinal abnormality in diabetic retinopathy is

Microaneurysm. ***Microaneurysm*** - **Microaneurysms** are the **earliest clinically detectable lesions** in diabetic retinopathy, forming as out-pouchings of weakened capillary walls. - They are typically seen as **small, red dots** on funduscopic examination and indicate initial capillary damage. *Hard exudates* - **Hard exudates** represent **lipid and lipoprotein deposits** and indicate leakage from damaged capillaries, usually appearing later than microaneurysms. - They are typically **yellow-white, shiny lesions** with distinct margins, often found in a circinate pattern around leaking vessels. *Soft exudates* - **Soft exudates**, also known as **cotton wool spots**, are microinfarctions of the retinal nerve fiber layer due to capillary occlusion, indicating more severe ischemia. - They appear as **fluffy, white patches** with indistinct borders and are generally a sign of more advanced retinopathy. *Flame-shaped hemorrhages* - **Flame-shaped hemorrhages** occur in the **nerve fiber layer** and typically indicate superficial retinal bleeding, often associated with hypertension. - While common in diabetic retinopathy, they are not the *first* abnormality, as microaneurysms precede them in the disease progression.

Q: All are seen in non-proliferative diabetic retinopathy except which of the following?

Neovascularization. ***Neovascularization*** - **Neovascularization** signifies the growth of new, fragile blood vessels and is a hallmark feature of **proliferative diabetic retinopathy**, not non-proliferative. - These new vessels can bleed, leading to vitreous hemorrhage and tractional retinal detachment, which are severe complications. *Microaneurysm* - **Microaneurysms** are the earliest clinical sign of diabetic retinopathy, visible as small, red dots on funduscopic examination due to capillary outpouchings. - They are characteristic findings in **non-proliferative diabetic retinopathy (NPDR)**. *Cotton wool spots* - **Cotton wool spots** are soft exudates resulting from microinfarcts in the retinal nerve fiber layer due to occluded precapillary arterioles. - They are findings commonly seen in **non-proliferative diabetic retinopathy (NPDR)**. *Retinal hemorrhages* - **Retinal hemorrhages** (dot-blot hemorrhages) occur when blood leaks from damaged capillaries in the retina. - They are a common occurrence in **non-proliferative diabetic retinopathy (NPDR)**.

Q: A young patient presents to the ophthalmology clinic with loss of central vision. The electroretinogram (ERG) is normal, but the electrooculogram (EOG) is abnormal. Which of the following is the most likely diagnosis?

Best's vitelliform dystrophy. ***Best's vitelliform dystrophy*** - This condition is characterized by an **abnormal electrooculogram (EOG)** with a normal electroretinogram (ERG). - It primarily affects the retinal pigment epithelium (**RPE**) and leads to **central vision loss** due to macula degeneration. *Stargardt's disease* - Patients typically present with **central vision loss** and a normal ERG, but the **EOG is also normal**, distinguishing it from Best's. - It is caused by mutations in the **ABCA4 gene** and results in progressive macular degeneration. *Retinitis pigmentosa* - This is a progressive degeneration of the **retina's photoreceptors**, leading to **night blindness** and **peripheral vision loss**. - Both the **ERG and EOG are typically abnormal**, reflecting widespread retinal dysfunction. *Cone-rod dystrophy* - This condition is also characterized by progressive **photoreceptor degeneration**, but primarily affecting **cones** more than rods initially, leading to central vision loss and color vision abnormalities. - Both **ERG and EOG would typically be abnormal**, showing reduced cone and rod responses.

Q: Condition where subhyaloid hemorrhage is associated with subarachnoid hemorrhage is what?

Terson's syndrome. ***Terson's syndrome*** - Terson's syndrome is characterized by **intraocular hemorrhage** (e.g., vitreous, subhyaloid, preretinal hemorrhage) associated with **subarachnoid hemorrhage**. - The presumed mechanism involves a sudden increase in **intracranial pressure (ICP)** during subarachnoid hemorrhage, leading to rupture of retinal capillaries or venules. *Posner-Schlossman syndrome* - This syndrome is a recurrent, unilateral **nongranulomatous anterior uveitis** associated with **elevated intraocular pressure**. - It is not directly associated with subarachnoid hemorrhage or subhyaloid bleeding. *Axenfeld-Rieger syndrome* - This is a rare, **autosomal dominant developmental disorder** affecting the anterior segment of the eye, often associated with systemic anomalies. - It can lead to **glaucoma** but does not involve subhyaloid hemorrhage linked to subarachnoid hemorrhage. *Pseudoexfoliation syndrome* - This condition is characterized by the production and deposition of an **extracellular fibrillar material** throughout the anterior segment of the eye. - It is a significant risk factor for **pseudoexfoliation glaucoma** and cataract formation but has no association with subarachnoid hemorrhage.

Q: What is the most likely diagnosis based on the findings of a fundus examination showing swelling of the optic disc?

Papilledema. **Papilledema** - **Papilledema** is defined as **swelling of the optic disc** due to increased **intracranial pressure** transmitted along the optic nerve sheath. - This condition is typically **bilateral** and is an important sign of underlying neurological pathology requiring urgent investigation. *Papillitis* - **Papillitis** is a form of **optic neuritis** where inflammation affects the optic nerve head, causing **unilateral vision loss** and optic disc swelling. - Unlike papilledema, papillitis is primarily an inflammatory process of the optic nerve itself, not necessarily caused by increased intracranial pressure. *Cupping of the disk* - **Cupping of the optic disc** refers to the enlargement and excavation of the central optic disc, which is characteristic of **glaucoma** due to progressive retinal ganglion cell loss. - This is a sign of nerve fiber layer damage and elevated intraocular pressure, distinctly different from optic disc swelling. *Silver wire appearance* - A **silver wire appearance** refers to the severe narrowing and sheathing of retinal arterioles, often seen in cases of **hypertensive retinopathy** or other severe retinal vascular diseases. - This finding indicates chronic vascular damage and is not associated with optic disc swelling.

Q: Which of the following is NOT a feature of Fuchs' Heterochromic Uveitis?

Posterior Synechiae. ***Posterior Synechiae*** - Posterior synechiae, which are **adhesions between the iris and the lens**, are notably absent in Fuchs' heterochromic uveitis. - This is because Fuchs' uveitis is characterized by a **mild, non-granulomatous inflammation** that does not typically lead to the formation of such adhesions. - The **absence of posterior synechiae** is a key distinguishing feature from other forms of chronic anterior uveitis. *Heterochromia* - **Heterochromia** (difference in iris color between the two eyes) is the **defining clinical feature** of this condition and gives it its name. - The affected eye typically shows a **lighter iris color** due to stromal atrophy and loss of pigment. - This feature is present in the majority of cases, though it may be subtle and sometimes only detected on careful examination. *Rubeosis iridis* - **Rubeosis iridis**, or the **formation of fine new blood vessels on the iris surface**, is a characteristic feature of Fuchs' heterochromic uveitis. - These fragile new vessels can lead to **spontaneous hyphema** (blood in the anterior chamber), particularly during intraocular surgery or paracentesis. *Stellate Keratic precipitate* - **Stellate keratic precipitates** (KPs), which are **small, star-shaped deposits** on the corneal endothelium, are a characteristic feature. - These KPs are **fine, diffuse, and scattered** over the entire corneal endothelium, unlike the larger, greasy KPs seen in granulomatous uveitis.

Q: A 2-year-old child presents with unilateral leukocoria and poor vision. What is the most likely diagnosis?

Retinoblastoma. ***Retinoblastoma*** - **Leukocoria** (white pupillary reflex) is the **most common presenting sign** of retinoblastoma, occurring in approximately 60% of cases - The combination of **unilateral leukocoria** and **poor vision** in a **2-year-old child** (peak age 18-24 months) is highly suggestive - It is a **rapidly growing malignant intraocular tumor** arising from the neural retina, requiring urgent evaluation and treatment - Other presenting features may include **strabismus**, **red eye**, and in advanced cases, **proptosis** *Congenital cataract* - Can also present with **leukocoria** due to opacification of the lens - However, congenital cataracts are typically **bilateral** (75% of cases) and diagnosed earlier in infancy - The **static, non-progressive nature** distinguishes it from the rapidly growing retinoblastoma - Family history and associated systemic conditions (TORCH infections, metabolic disorders) are common *Endophthalmitis* - Severe **intraocular infection** affecting vitreous and aqueous humor - Typically presents with **acute pain**, **severe redness**, **hypopyon**, and **rapid vision loss** - Usually follows **penetrating trauma** or **intraocular surgery**, which would be uncommon in a 2-year-old - **Leukocoria without acute inflammatory signs** makes this diagnosis unlikely *Coats disease* - Characterized by **abnormal telangiectatic retinal vessels** with **exudative retinal detachment** and **yellow subretinal exudates** - Can present with leukocoria (yellow reflex due to lipid deposits) in young children - However, it typically affects **older children** (mean age 5-8 years), is predominantly **unilateral**, and has a **more indolent course** - More common in **males** and usually lacks the rapid progression of retinoblastoma

Q: All of the following cause panuveitis except?

Ankylosing spondylitis. ***Ankylosing spondylitis*** - This condition primarily causes **acute anterior uveitis**, affecting the front part of the eye, not typically the entire uveal tract (**panuveitis**). - Its association with uveitis is usually **unilateral** and presents with symptoms like pain, redness, and photophobia. *Sarcoidosis* - **Sarcoidosis** is a systemic inflammatory disease that can lead to **granulomatous panuveitis**, affecting the anterior, intermediate, and posterior segments of the eye. - Ocular involvement in sarcoidosis can manifest as choroiditis, retinitis, and vitritis, indicative of widespread inflammation. *Sympathetic ophthalmitis* - This is a rare, bilateral, **granulomatous panuveitis** that occurs after a penetrating ocular injury or surgery to one eye. - It involves inflammation of the entire uveal tract in both the injured and the fellow, uninjured eye. *Toxoplasmosis* - **Toxoplasmosis** often causes a focal **retinochoroiditis** which can spread to involve the vitreous and anterior chamber, leading to a form of **panuveitis**. - The inflammatory response is primarily to the parasitic infection, manifesting as a necrotizing retinitis with significant surrounding inflammation.

Question 1

Fluorescein dye study is done to detect:

Accepted Answer

Retinal vascular pathology

Answer

Posterior segment of eye

Answer

Assess retinal vascular conditions in babies

Answer

Macular vascular pathology

Question 2

Treatment of choice for clinically significant macular edema in a diabetic is?

Accepted Answer

Intravitreal anti-VEGF injections

Answer

Control of Diabetes

Answer

Panretinal Photocoagulation

Answer

Focal Photocoagulation

Question 3

First retinal abnormality in diabetic retinopathy is

Accepted Answer

Microaneurysm

Answer

Hard exudates

Answer

Soft exudates

Answer

Flame-shaped hemorrhages

Question 4

All are seen in non-proliferative diabetic retinopathy except which of the following?

Accepted Answer

Neovascularization

Answer

Microaneurysm

Answer

Cotton wool spots

Answer

Retinal hemorrhages

Question 5

A young patient presents to the ophthalmology clinic with loss of central vision. The electroretinogram (ERG) is normal, but the electrooculogram (EOG) is abnormal. Which of the following is the most likely diagnosis?

Accepted Answer

Best's vitelliform dystrophy

Answer

Stargardt's disease

Answer

Retinitis pigmentosa

Answer

Cone-rod dystrophy

Question 6

Condition where subhyaloid hemorrhage is associated with subarachnoid hemorrhage is what?

Accepted Answer

Terson's syndrome

Answer

Posner-Schlossman syndrome

Answer

Pseudoexfoliation syndrome

Answer

Axenfeld-Rieger syndrome

Question 7

What is the most likely diagnosis based on the findings of a fundus examination showing swelling of the optic disc?

Accepted Answer

Papilledema

Answer

Papillitis

Answer

Cupping of the disk

Answer

Silver wire appearance

Question 8

Which of the following is NOT a feature of Fuchs' Heterochromic Uveitis?

Accepted Answer

Posterior Synechiae

Answer

Heterochromia

Answer

Rubeosis iridis

Answer

Stellate Keratic precipitate

Question 9

A 2-year-old child presents with unilateral leukocoria and poor vision. What is the most likely diagnosis?

Accepted Answer

Retinoblastoma

Answer

Congenital cataract

Answer

Endophthalmitis

Answer

Coats disease

Question 10

All of the following cause panuveitis except?

Accepted Answer

Ankylosing spondylitis

Answer

Sarcoidosis

Answer

Sympathetic ophthalmitis

Answer

Toxoplasmosis

Diseases of the Retina — MCQs

Diseases of the Retina — MCQs

On this page

Practice by Chapter

Want unlimited practice?