Hypertension — MCQs
A 45-year-old diabetic presents with sudden painless vision loss. Cotton wool spots and dot hemorrhages seen. HbA1c is 9.2. Most likely diagnosis?
Kayser-Fleischer rings (KF rings) are seen in:
What is the most common cause of vitreous hemorrhage in diabetic retinopathy?
Which of the following is seen in retinitis pigmentosa?
An elderly woman presented with gradual painless diminution of vision. The fundus picture is shown below. What is the most likely diagnosis?
In a patient with AIDS, what typically causes chorioretinitis?
What is one of the most common complications of iridocyclitis?
Sudden painful diminition of vision in Anterior Uveitis is due to?
What is the most common causative organism of canaliculitis?
Which of the following can cause uveitis?
Hypertension Indian Medical PG Practice Questions and MCQs
Question 1: A 45-year-old diabetic presents with sudden painless vision loss. Cotton wool spots and dot hemorrhages seen. HbA1c is 9.2. Most likely diagnosis?
- A. Hypertensive retinopathy
- B. CRAO
- C. Diabetic retinopathy (Correct Answer)
- D. CRVO
Explanation: ***Diabetic retinopathy*** - The presence of **cotton wool spots** and **dot hemorrhages** in a diabetic patient with poor glycemic control (HbA1c 9.2) are classic signs of **diabetic retinopathy**. - **Painless vision loss** is a common presentation, especially with macular edema or proliferative disease. *Hypertensive retinopathy* - While cotton wool spots can be seen, **dot hemorrhages are less characteristic** than flame-shaped hemorrhages. - The primary driver here is **diabetes** and poor glycemic control, not necessarily hypertension as the main cause. *CRAO* - **Central retinal artery occlusion** typically presents with **sudden, profound, painless monocular vision loss**. - Funduscopic examination would reveal a **cherry-red spot** and **pale retina**, not cotton wool spots and dot hemorrhages. *CRVO* - **Central retinal vein occlusion** is characterized by **extensive retinal hemorrhages** (often described as "blood and thunder" appearance), tortuous veins, and optic disc edema. - While it can cause painless vision loss and some hemorrhages, the specific combination of **cotton wool spots and dot hemorrhages** in a diabetic context points more strongly to diabetic retinopathy.
Question 2: Kayser-Fleischer rings (KF rings) are seen in:
- A. Pterygium
- B. Hemochromatosis
- C. Wilson's disease (Correct Answer)
- D. Menke's kinked hair syndrome
Explanation: ***Wilson's disease*** - **Kayser-Fleischer (KF) rings** are pathognomonic for **Wilson's disease**, resulting from **copper deposition** in the Descemet's membrane of the cornea. - This genetic disorder leads to excessive **copper accumulation** in the liver, brain, and other tissues due to impaired copper excretion. *Pterygium* - A **pterygium** is a benign growth of the **conjunctiva** that extends onto the cornea, typically appearing as a fleshy, triangular lesion. - It is not associated with systemic copper metabolism disorders or the presence of KF rings. *Hemochromatosis* - **Hemochromatosis** is a disorder of **iron overload**, leading to iron deposition in various organs, including the liver, heart, and pancreas. - It does not involve copper metabolism or the formation of corneal rings. *Menke's kinked hair syndrome* - **Menke's syndrome** is a genetic disorder characterized by **copper deficiency**, leading to impaired copper transport and utilization. - It presents with severe neurological deterioration, connective tissue abnormalities, and characteristic **kinky hair**, but not KF rings.
Question 3: 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 4: Which of the following is seen in retinitis pigmentosa?
- A. Arteriolar attenuation (Correct Answer)
- B. Neovascularization
- C. Papilledema
- D. Retinal artery thrombosis
Explanation: ***Arteriolar attenuation*** - **Arteriolar attenuation** is a classic finding in retinitis pigmentosa, reflecting the progressive loss of retinal tissue and the associated reduction in metabolic demand, leading to narrowing of the retinal arterioles. - This sign indicates the ongoing degeneration of photoreceptors and the underlying retinal layers, which is characteristic of the disease. *Neovascularization* - **Neovascularization** (abnormal new blood vessel growth) is typically associated with conditions like proliferative diabetic retinopathy or age-related macular degeneration. - It is not a primary feature of retinitis pigmentosa, which is a degenerative disease rather than an ischemic or proliferative one. *Papilledema* - **Papilledema** is swelling of the optic disc due to increased intracranial pressure. - It is not a feature of retinitis pigmentosa; rather, the optic disc in retinitis pigmentosa often appears waxy pale due to optic atrophy. *Retinal artery thrombosis* - **Retinal artery thrombosis** involves the sudden blockage of a retinal artery, leading to acute vision loss and often presenting with a 'cherry-red spot' on the macula. - This is an acute vascular event and is not characteristic of the chronic, progressive degeneration seen in retinitis pigmentosa.
Question 5: An elderly woman presented with gradual painless diminution of vision. The fundus picture is shown below. What is the most likely diagnosis?
- A. Central Retinal Artery Occlusion (CRAO)
- B. Hypertensive Retinopathy
- C. Central Retinal Vein Occlusion (CRVO) (Correct Answer)
- D. Diabetic Retinopathy
Explanation: ***Central Retinal Vein Occlusion (CRVO)*** - The image displays characteristic findings of CRVO, including **widespread retinal hemorrhages**, **dilated and tortuous retinal veins**, and **cotton wool spots**. - The presence of **macular edema** (indicated by the bright, somewhat circular lesion near the center with surrounding exudates) also points to CRVO, which causes gradual, painless vision loss. *Central Retinal Artery Occlusion (CRAO)* - CRAO typically presents with sudden, profound, and painless vision loss, and the classic fundoscopic finding is a **cherry-red spot** in the macula with diffuse retinal whitening due to ischemia. - The image does not show these features; instead, it shows significant hemorrhages and dilated veins, which are inconsistent with CRAO. *Hypertensive Retinopathy* - Hypertensive retinopathy might show **arteriolar narrowing**, **AV nipping**, **cotton wool spots**, and sometimes hemorrhages, but the widespread, severe hemorrhages and marked venous dilation seen here are much more typical of CRVO. - While it can cause vision changes, the pattern of ocular findings is less severe and more chronic compared to the acute presentation of CRVO. *Diabetic Retinopathy* - Diabetic retinopathy can involve dot-blot hemorrhages, microaneurysms, hard exudates, and sometimes cotton wool spots, but the extensive, diffuse retinal hemorrhages in all four quadrants, along with the severely dilated and tortuous veins shown, are not the primary distinguishing features of typical diabetic retinopathy stages. - While **proliferative diabetic retinopathy (PDR)** can involve hemorrhages, the pattern in the image strongly suggests a vascular occlusion rather than the progressive microvascular damage of diabetes.
Question 6: In a patient with AIDS, what typically causes chorioretinitis?
- A. Cytomegalovirus (Correct Answer)
- B. Toxoplasma gondii
- C. Cryptococcus neoformans
- D. Histoplasma capsulatum
Explanation: **Explanation:** **1. Why Cytomegalovirus (CMV) is Correct:** Cytomegalovirus (CMV) retinitis is the **most common opportunistic ocular infection** in patients with AIDS, typically occurring when the CD4+ T-cell count falls below **50 cells/mm³**. It is a full-thickness necrotizing retinitis. The classic clinical appearance is described as **"Pizza-pie" or "Cheese and Ketchup" retinopathy**, characterized by areas of white retinal necrosis mixed with prominent retinal hemorrhages and vasculitis. **2. Why the Other Options are Incorrect:** * **Toxoplasma gondii:** While it causes chorioretinitis, it is less common than CMV in AIDS patients. It typically presents as a "headlight in the fog" appearance (focal retinitis with overlying vitritis). In AIDS, it often presents as a reactivation of a previous infection. * **Cryptococcus neoformans:** This primarily causes fungal meningitis. Ocular involvement is usually secondary to increased intracranial pressure (papilledema) or direct optic nerve infiltration, rather than primary chorioretinitis. * **Histoplasma capsulatum:** Causes "Presumed Ocular Histoplasmosis Syndrome" (POHS), characterized by "punched-out" chorioretinal scars, peripapillary atrophy, and maculopathy. It is not specifically associated with the immunosuppression levels seen in AIDS. **3. High-Yield Clinical Pearls for NEET-PG:** * **CD4 Count Threshold:** CMV Retinitis = CD4 < 50 cells/mm³. * **Drug of Choice:** **Ganciclovir** (Intravenous or Intravitreal implants). Foscarnet and Cidofovir are alternatives. * **Immune Recovery Uveitis (IRU):** A paradoxical inflammatory response occurring in AIDS patients after starting HAART as their CD4 count rises. * **Cotton Wool Spots:** These are the most common *non-infectious* ocular finding in AIDS (part of HIV microangiopathy), but they do not represent true chorioretinitis.
Question 7: What is one of the most common complications of iridocyclitis?
- A. Scleritis
- B. Secondary glaucoma (Correct Answer)
- C. Band-shaped keratopathy
- D. Corneal ulcer
Explanation: **Explanation:** **Iridocyclitis** (anterior uveitis) is characterized by inflammation of the iris and ciliary body. **Secondary glaucoma** is one of the most common and vision-threatening complications of this condition. It occurs via two primary mechanisms: 1. **Open-angle mechanism:** Inflammatory debris (cells, fibrin, and pigment) clogs the trabecular meshwork, or "trabeculitis" reduces outflow facility. 2. **Closed-angle mechanism:** Formation of **posterior synechiae** (adhesions between the iris and lens) leads to *seclusio pupillae*. This obstructs aqueous flow from the posterior to the anterior chamber, causing **iris bombé** and subsequent angle closure. **Analysis of Incorrect Options:** * **Scleritis (A):** This is an inflammation of the outer coat of the eye. While systemic diseases (like Rheumatoid Arthritis) can cause both uveitis and scleritis, one does not typically occur as a *complication* of the other. * **Band-shaped Keratopathy (C):** This is a classic complication of **chronic** uveitis (especially in Juvenile Idiopathic Arthritis) due to calcium deposition in Bowman’s layer. While common in chronic cases, secondary glaucoma occurs more frequently across both acute and chronic presentations. * **Corneal Ulcer (D):** This is typically caused by infection or trauma. Iridocyclitis may cause corneal edema or keratic precipitates (KPs), but it does not directly cause ulceration. **High-Yield Clinical Pearls for NEET-PG:** * **Most common cause of death in Uveitis:** Not applicable, but the most common cause of **blindness** in uveitis is **Cystoid Macular Edema (CME)**. * **Festooned Pupil:** Irregular pupil shape caused by patchy posterior synechiae; a hallmark of previous iridocyclitis. * **Treatment Note:** Atropine is used in iridocyclitis to provide ciliary rest and prevent the formation of posterior synechiae.
Question 8: Sudden painful diminition of vision in Anterior Uveitis is due to?
- A. Blood in Anterior chamber
- B. Cells in Anterior chamber
- C. Edema of Cornea
- D. Ciliary muscle spasm (Correct Answer)
Explanation: **Explanation:** In **Anterior Uveitis** (Iridocyclitis), the inflammation of the iris and ciliary body leads to a classic triad of symptoms: pain, photophobia, and blurred vision. **1. Why Ciliary Muscle Spasm is correct:** The hallmark of pain and sudden visual disturbance in acute anterior uveitis is the **spasm of the ciliary muscle and the iris sphincter**. The inflammation irritates these smooth muscles, causing them to contract uncontrollably. This spasm results in: * **Pain:** A deep, throbbing ache (ciliary neuralgia). * **Diminution of vision:** The spasm induces "accommodative spasm," shifting the refractive state toward myopia (pseudomyopia), which causes blurring of distance vision. **2. Analysis of Incorrect Options:** * **A. Blood in Anterior chamber (Hyphema):** While blood can cause sudden vision loss, it is not a standard feature of primary anterior uveitis unless it is traumatic or associated with specific syndromes like Fuchs' Heterochromic Iridocyclitis (Amsler sign). * **B. Cells in Anterior chamber:** While "cells and flare" are the diagnostic signs of uveitis, they typically cause a gradual "mistiness" or "haze" rather than sudden painful diminution. * **C. Edema of Cornea:** This occurs in late stages or if there is secondary glaucoma (due to high IOP). While it causes blurred vision, it is a secondary complication rather than the primary cause of the initial painful spasm. **Clinical Pearls for NEET-PG:** * **Treatment Gold Standard:** Cycloplegics (e.g., **Atropine or Homatropine**) are used specifically to paralyze the ciliary muscle, thereby relieving the spasm and the associated pain. * **Miosis:** The iris sphincter spasm leads to a small, sluggishly reacting pupil, which helps differentiate uveitis from Acute Congestive Glaucoma (where the pupil is mid-dilated). * **Ciliary Flush:** The characteristic redness in uveitis is due to the engorgement of anterior ciliary vessels.
Question 9: What is the most common causative organism of canaliculitis?
- A. Herpes simplex virus (HSV)
- B. Candida albicans
- C. Actinomyces israelii (Correct Answer)
- D. Nocardia asteroides
Explanation: **Explanation:** **Canaliculitis** is a chronic inflammatory condition of the lacrimal canaliculi. The correct answer is **Actinomyces israelii**, which is historically and clinically recognized as the most common causative agent. 1. **Why Actinomyces israelii is correct:** * *Actinomyces israelii* is a Gram-positive, anaerobic, branching filamentous bacterium (often misclassified as a fungus in older texts). * It leads to the formation of characteristic **"sulfur granules"** or dacryoliths (concretions) within the canaliculus. These concretions cause mechanical obstruction and chronic discharge. 2. **Analysis of Incorrect Options:** * **Herpes simplex virus (HSV):** While HSV can cause viral canaliculitis (often leading to secondary canalicular stenosis), it is much less common than bacterial causes. * **Candida albicans:** Fungal canaliculitis is rare and typically occurs in immunocompromised patients or following prolonged topical steroid/antibiotic use. * **Nocardia asteroides:** Although Nocardia is a filamentous bacterium similar to Actinomyces, it is a much rarer cause of this specific ocular infection. **High-Yield Clinical Pearls for NEET-PG:** * **Classic Presentation:** A "pouty" punctum (erythematous and dilated), chronic epiphora, and unilateral conjunctivitis localized to the nasal side. * **Diagnostic Sign:** Expression of yellow, "cheesy" material or **sulfur granules** upon massaging the canaliculus. * **Management:** The definitive treatment is **canaliculotomy** with curettage of the concretions, as topical antibiotics cannot penetrate the dacryoliths. * **Differential Diagnosis:** Often misdiagnosed as chronic conjunctivitis or dacryocystitis; however, in canaliculitis, the lacrimal sac is usually not involved, and the "regurgitation test" is negative.
Question 10: Which of the following can cause uveitis?
- A. Tuberculosis
- B. Staphylococcus (Correct Answer)
- C. Streptococcus
- D. Klebsiella
Explanation: **Explanation:** Uveitis is the inflammation of the uveal tract (iris, ciliary body, and choroid). While many systemic diseases cause uveitis through immunological mechanisms, direct infectious seeding or hypersensitivity to specific bacteria are high-yield topics for NEET-PG. **Why Staphylococcus is the correct answer:** *Staphylococcus aureus* is a leading cause of **exogenous endophthalmitis** (which involves severe uveal inflammation) following ocular surgery or trauma. More specifically, it is a common cause of **metastatic (endogenous) endophthalmitis** and can trigger anterior uveitis. In the context of this question, *Staphylococcus* is recognized as a primary pyogenic organism capable of inducing direct suppurative uveal inflammation. **Analysis of Incorrect Options:** * **Tuberculosis (Option A):** While *Mycobacterium tuberculosis* is a major cause of granulomatous uveitis, it is technically a "Mycobacterium," not a typical bacterium. In many standard textbooks and competitive exams, if a single pyogenic organism is sought as a primary cause of acute suppurative uveitis/endophthalmitis, *Staphylococcus* is prioritized. * **Streptococcus (Option C):** Although it can cause endophthalmitis, it is less frequently isolated than *Staphylococcus* in post-operative scenarios. * **Klebsiella (Option D):** This is a common cause of endogenous endophthalmitis, particularly in patients with liver abscesses or diabetes, but *Staphylococcus* remains the more common general cause of infectious uveal involvement. **NEET-PG High-Yield Pearls:** 1. **Most common cause of Post-operative Endophthalmitis:** *Staphylococcus epidermidis* (Coagulase-negative Staph). 2. **HLA-B27 Association:** The most common systemic association with non-infectious acute anterior uveitis (Ankylosing Spondylitis). 3. **Snowball/Snowbank appearance:** Pathognomonic for **Pars Planitis** (Intermediate Uveitis). 4. **Mutton-fat Keratic Precipitates:** Indicative of **Granulomatous Uveitis** (e.g., TB, Sarcoidosis, Syphilis).
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