Pregnancy-Related Eye Changes — MCQs

10 questions

Which of the following is false regarding management of diabetes in pregnancy?

A pregnant woman presents with fever, retroorbital pain, headache, pulsatile proptosis of the right eye, and tinnitus. BP and fundus were normal. Which of the following structures are involved?

What is the primary predisposing factor for retinopathy of prematurity?

What is the management of eclampsia at 34 weeks of pregnancy?

Constantly changing refractive error is seen in:

All of the following are true for retinopathy of prematurity except which of the following?

A female of 36 weeks' gestation presents with severe hypertension, blurring of vision, and headache. Her blood pressure readings are 180/120 mmHg and 174/110 mmHg after 20 minutes. What is the most appropriate management for this patient?

Balloon valvotomy is successful in all of the following cases except-

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

Q10

40-year-old male with spherophakia is at risk for developing

Pregnancy-Related Eye Changes Indian Medical PG Practice Questions and MCQs

Question 1: Which of the following is false regarding management of diabetes in pregnancy?

A. In active labor, if RBS <70 mg/dL, D5 is started at 100-150 ml/hr till the RBS is >70 mg/dL
B. In a patient being planned for induction of labor, night dose of intermediate insulin is given as planned, and the morning dose is withheld
C. Elective C-section has no role in reducing incidence of brachial plexus injury (Correct Answer)
D. Capillary blood glucose monitoring levels are kept at fasting- 95 mg/dL; 1 hr postprandial- 140 mg/dL; 2 hrs postprandial- 120 mg/dL

Explanation: ***Elective C-section has no role in reducing incidence of brachial plexus injury*** - This statement is **false** because **elective C-section** can significantly reduce the incidence of **brachial plexus injury** (BPI), especially in cases of suspected fetal macrosomia. - While not universally recommended for all diabetic pregnancies, an elective C-section is considered when the estimated **fetal weight** is substantial or when there's a history of **shoulder dystocia** to prevent birth trauma. *In active labor, if RBS <70 mg/dL, D5 is started at 100-150 ml/hr till the RBS is >70 mg/dL* - This is a **correct** management strategy for **hypoglycemia in labor**. Maintaining stable blood glucose levels (above 70 mg/dL) is crucial to prevent adverse outcomes for both mother and fetus. - The administration of **D5 (dextrose 5% in water)** intravenous solution at a specific rate helps to quickly raise and maintain blood glucose levels. *In a patient being planned for induction of labor, night dose of intermediate insulin is given as planned, and the morning dose is withheld* - This is a common and generally **correct** practice for insulin management before **induction of labor**. The night dose of intermediate insulin helps maintain basal glucose levels overnight. - Withholding the morning dose prevents **hypoglycemia** during labor when food intake is restricted, and insulin sensitivity may increase. Glucose is then typically supplemented through IV fluids as needed. *Capillary blood glucose monitoring levels are kept at fasting- 95 mg/dL; 1 hr postprandial- 140 mg/dL; 2 hrs postprandial- 120 mg/dL* - These are the generally accepted and **correct** target blood glucose levels for **diabetes in pregnancy** (both pre-existing and gestational diabetes). - Achieving these targets is essential to minimize the risk of **fetal macrosomia**, **neonatal hypoglycemia**, and other adverse perinatal outcomes.

Question 2: A pregnant woman presents with fever, retroorbital pain, headache, pulsatile proptosis of the right eye, and tinnitus. BP and fundus were normal. Which of the following structures are involved?

A. Oculomotor nerve, Internal carotid artery, Cavernous sinus
B. Abducens nerve, Internal carotid artery, Cavernous sinus
C. Abducens nerve, Oculomotor nerve, Internal carotid artery
D. Abducens nerve, Oculomotor nerve, Internal carotid artery, Cavernous sinus (Correct Answer)

Explanation: Abducens nerve, Oculomotor nerve, Internal carotid artery, Cavernous sinus - The combination of retroorbital pain, pulsatile proptosis, and tinnitus in a pregnant woman (indicating a potential hypercoagulable state) strongly suggests a carotid-cavernous fistula. - A carotid-cavernous fistula directly connects the high-pressure internal carotid artery to the low-pressure cavernous sinus, causing engorgement of the sinus and venous backflow. This can directly impact structures passing through or adjacent to the cavernous sinus, explaining the range of symptoms. - The oculomotor nerve (CN III) and abducens nerve (CN VI) both traverse the cavernous sinus and are commonly affected, leading to ophthalmoplegia and cranial nerve palsies. Abducens nerve, Oculomotor nerve, Internal carotid artery - This option incorrectly omits the cavernous sinus, which is central to the pathophysiology of the symptoms presented. - The cavernous sinus is the anatomical location where the internal carotid artery and multiple cranial nerves (including abducens and oculomotor) are in close proximity, making its involvement crucial for the observed signs. Oculomotor nerve, Internal carotid artery, Cavernous sinus - This option incorrectly omits the abducens nerve. While not explicitly stated as palsy, this nerve is often affected alongside the oculomotor nerve due to its passage through the cavernous sinus. - Involvement of the cavernous sinus often leads to dysfunction of cranial nerves III, IV, V1, V2, and VI, making abducens nerve involvement highly probable in such cases. Abducens nerve, Internal carotid artery, Cavernous sinus - This option incorrectly omits the oculomotor nerve. Pulsatile proptosis and retroorbital pain are strong indicators of cavernous sinus pathology, which frequently involves the oculomotor nerve (CN III), leading to ophthalmoplegia or partial palsies. - The oculomotor nerve is particularly vulnerable due to its course within the lateral wall of the cavernous sinus, making its involvement a common finding in cavernous sinus disorders.

Question 3: What is the primary predisposing factor for retinopathy of prematurity?

A. Oxygen toxicity
B. Carbohydrate excess
C. Low birth weight
D. Low gestational age (Correct Answer)

Explanation: ***Low gestational age*** - **Prematurity** is the most significant risk factor, as the **retinal vasculature** is still immature and susceptible to abnormal development. - The earlier the gestational age, the **higher the risk** of ROP developing and progressing to severe stages. *Low birth weight* - While strongly correlated with ROP, **low birth weight** is often a consequence of prematurity rather than the primary predisposing factor itself. - Many term infants can have low birth weight due to **intrauterine growth restriction** but do not typically develop ROP. *Oxygen toxicity* - **Supplemental oxygen** can exacerbate ROP by causing initial **vasoconstriction** and subsequent abnormal vessel proliferation. - However, it acts as a secondary trigger in an already vulnerable, premature retina, not the primary predisposing factor. *Carbohydrate excess* - **Carbohydrate excess** is not a recognized predisposing factor for retinopathy of prematurity. - This condition is primarily related to the **vascular development of the retina** in premature infants.

Question 4: What is the management of eclampsia at 34 weeks of pregnancy?

A. Continue convulsions and wait for 37 weeks to complete.
B. Wait for spontaneous labor.
C. Continue blood pressure management.
D. Administer antihypertensives, anticonvulsants, and consider termination of pregnancy. (Correct Answer)

Explanation: **Administer antihypertensives, anticonvulsants, and consider termination of pregnancy.** - In eclampsia, emergent management includes immediate administration of **magnesium sulfate** as an anticonvulsant and **antihypertensives** (e.g., labetalol, hydralazine, nifedipine) to control blood pressure. - Given the gestational age of 34 weeks and the occurrence of eclampsia, **delivery of the fetus** is often indicated to resolve the maternal condition, regardless of fetal lung maturity. *Continue convulsions and wait for 37 weeks to complete.* - Allowing **convulsions to continue** is extremely dangerous for both mother and fetus, increasing risks of aspiration, trauma, hypoxemia, and placental abruption. - Eclampsia is a severe complication of pregnancy that necessitates immediate intervention and **should not be passively observed** until full term. *Wait for spontaneous labor.* - **Delaying delivery** while waiting for spontaneous labor in eclampsia significantly prolongs the mother's exposure to the severe complications of the condition. - Eclampsia is an ** obstetric emergency** where prompt delivery, often via induction or C-section, is the definitive cure. *Continue blood pressure management.* - While **blood pressure management** is a crucial component of eclampsia treatment, it is insufficient on its own. - Eclampsia specifically involves **seizures**, which require anticonvulsant therapy (magnesium sulfate) in addition to antihypertensives, and the ultimate treatment is delivery.

Question 5: Constantly changing refractive error is seen in:

A. Morgagnian cataract
B. Intumescent cataract
C. Traumatic cataract
D. Diabetic cataract (Correct Answer)

Explanation: ***Diabetic cataract*** - Fluctuating blood glucose levels in diabetes can cause changes in the **osmolarity of the aqueous humor**, which in turn affects the hydration of the lens and its refractive power. - This leads to a **constantly changing refractive error**, where a person's prescription might change rapidly over short periods of time. *Morgagnian cataract* - This is a type of **hypermature cataract** where the cortex has liquefied, allowing the nucleus to sink within the capsular bag. - While vision is severely impaired, it doesn't typically present with a constantly changing refractive error, but rather a stable, significant vision loss. *Intumescent cataract* - An **intumescent cataract** is a mature or hypermature cataract where the lens has become significantly swollen due to water absorption. - This swelling causes the anterior capsule to stretch, but it results in a fixed and profound vision loss, not a fluctuating refractive error. *Traumatic cataract* - A **traumatic cataract** develops as a result of blunt or penetrating ocular injury, causing damage to the lens fibers. - While the specific type of refractive error can vary depending on the trauma, it typically presents as a stable visual impairment rather than a constantly changing refractive error.

Question 6: All of the following are true for retinopathy of prematurity except which of the following?

A. Due to hypoxia there occurs neovascularization followed by fibroproliferation
B. Occurs in premature infants due to abnormal retinal blood vessel development.
C. End result is bilateral blindness (Correct Answer)
D. Blindness can be prevented by early diagnosis and ablation of avascular peripheral retina with cryotherapy or photocoagulation

Explanation: ***End result is bilateral blindness*** - While retinopathy of prematurity (ROP) can lead to severe vision loss or blindness, it is not always a bilateral end result, especially with early diagnosis and treatment. The severity can vary between eyes, and some cases resolve spontaneously. - Modern screening and intervention strategies, such as laser photocoagulation or anti-VEGF injections, are often successful in preventing complete blindness in one or both eyes. *Due to hypoxia there occurs neovascularization followed by fibroproliferation* - This statement accurately describes the pathogenesis of ROP. The initial phase involves delayed normal retinal vascularization, followed by a proliferative phase characterized by **neovascularization** in response to hypoxia in the avascular retina. - These new, abnormal vessels are fragile and prone to bleeding, and their associated **fibrovascular proliferation** can lead to retinal detachment. *Blindness can be prevented by early diagnosis and ablation of vascular premature retina with cryotherapy or photocoagulation* - This is a true statement. **Early diagnosis** through ophthalmologic screening of premature infants is crucial, and treatments like **laser photocoagulation** or **cryotherapy** are effective in ablating the avascular peripheral retina to halt the progression of abnormal vessel growth. - These interventions reduce the hypoxic drive that fuels neovascularization, thereby preventing severe retinal detachment and subsequent blindness. *Occurs in premature infants due to abnormal retinal blood vessel development.* - This statement is correct. ROP is a disease primarily affecting **premature infants** because their retinal blood vessels have not completed development by the time of birth. - Postnatal factors, including oxygen fluctuations and low birth weight, further disrupt this critical development, leading to **abnormal vascularization**.

Question 7: A female of 36 weeks' gestation presents with severe hypertension, blurring of vision, and headache. Her blood pressure readings are 180/120 mmHg and 174/110 mmHg after 20 minutes. What is the most appropriate management for this patient?

A. Admit the patient, start antihypertensives, administer MgSO4, and plan for delivery. (Correct Answer)
B. Admit the patient and monitor her condition.
C. Discharge the patient with oral antihypertensives and schedule a follow-up.
D. Admit the patient, initiate antihypertensive therapy, and continue the pregnancy until term.

Explanation: ***Admit the patient, start antihypertensives, administer MgSO4, and plan for delivery.*** - The patient's symptoms (**severe hypertension**, **blurring of vision**, **headache**) at **36 weeks' gestation** indicate severe preeclampsia, necessitating immediate admission and management to prevent complications. - **Antihypertensives** are crucial to control severe hypertension, **magnesium sulfate (MgSO4)** prevents eclamptic seizures, and **delivery** is the definitive treatment for severe preeclampsia, especially near term. *Admit the patient and monitor her condition.* - While admission is correct, merely monitoring is insufficient given the patient's severe symptoms and high blood pressure readings, which indicate an urgent need for active management. - Delaying treatment could lead to serious maternal or fetal complications such as **eclampsia** or **placental abruption**. *Discharge the patient with oral antihypertensives and schedule a follow-up.* - Discharging a patient with severe preeclampsia is highly inappropriate and dangerous, as it puts both the mother and fetus at significant risk. - Oral antihypertensives alone are insufficient to manage severe preeclampsia acutely, and close monitoring and definitive treatment are required. *Admit the patient, initiate antihypertensive therapy, and continue the pregnancy until term.* - Although admitting the patient and starting antihypertensives are correct initial steps, continuing the pregnancy until term is generally not advisable with **severe preeclampsia** at **36 weeks' gestation**. - The risks associated with continuing the pregnancy often outweigh the benefits, and delivery is usually indicated to resolve the condition and prevent further progression.

Question 8: Balloon valvotomy is successful in all of the following cases except-

A. Calcified mitral stenosis (Correct Answer)
B. Congenital aortic stenosis
C. Congenital pulmonary stenosis
D. Mitral stenosis in pregnancy

Explanation: ***Calcified mitral stenosis*** - **Balloon valvotomy is LEAST successful** in **calcified mitral stenosis** due to the reduced ability of the calcified valve leaflets to split properly, increasing the risk of suboptimal results and complications like **mitral regurgitation**. - The presence of **significant calcification** (Wilkins score >8) is a relative **contraindication** and often necessitates **surgical valve replacement** rather than percutaneous repair. - Heavy calcification predicts poor outcomes with high rates of procedural failure and need for early surgery. *Congenital aortic stenosis* - Balloon valvotomy can be performed for **congenital aortic stenosis**, particularly in children and young adults as a **palliative or temporizing measure**. - However, it has **significant limitations** including high rates of **restenosis** (up to 25-40%) and **aortic regurgitation**, often requiring repeat intervention or surgical valve replacement. - It is less successful than balloon valvotomy for pulmonary stenosis but may provide symptomatic relief and delay the need for surgery in selected cases. *Congenital pulmonary stenosis* - **Congenital pulmonary stenosis** is the **MOST FAVORABLE** condition for **balloon valvotomy**, with high success rates (>90%) and excellent long-term outcomes, especially for isolated valvar stenosis. - It is the **treatment of choice** (gold standard) for significant valvar pulmonary stenosis and effectively relieves right ventricular outflow obstruction. *Mitral stenosis in pregnancy* - **Balloon mitral valvotomy** is a safe and effective treatment option for **severe mitral stenosis** during **pregnancy** when valve morphology is favorable (pliable, non-calcified valves). - It can alleviate symptoms and improve maternal and fetal outcomes without exposing the fetus to the risks of cardiopulmonary bypass required for open-heart surgery. - The procedural risk is generally low, and it helps manage the increased hemodynamic burden of pregnancy.

Question 9: Treatment of choice for clinically significant macular edema in a diabetic is?

A. Intravitreal anti-VEGF injections (Correct Answer)
B. Control of Diabetes
C. Panretinal Photocoagulation
D. Focal Photocoagulation

Explanation: ***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.

Question 10: 40-year-old male with spherophakia is at risk for developing

A. Phacolytic glaucoma
B. Phacoanaphylactic glaucoma
C. Phacomorphic glaucoma (Correct Answer)
D. Obscuration of disc margins

Explanation: ***Phacomorphic glaucoma*** - **Spherophakia** describes a small, spherical lens that can become swollen, leading to a shallow anterior chamber and subsequent **angle closure glaucoma**. - This condition is termed **phacomorphic glaucoma** when the increase in lens size and shape directly causes obstruction of aqueous outflow. *Phacolytic glaucoma* - This type of glaucoma results from a **leaky lens capsule** in a hypermature cataract, releasing high-molecular-weight proteins that clog the trabecular meshwork. - It is not directly associated with the small, spherical shape of the lens seen in spherophakia. *Phacoanaphylactic glaucoma* - This is an inflammatory response to **lens protein exposure** following trauma or surgery, leading to a granulomatous reaction. - It involves an immune reaction to lens material and is not typically a direct consequence of spherophakia itself. *Obscuration of disc margins* - **Optic disc obscuration** (papilledema) is a sign of increased intracranial pressure, not a direct complication of spherophakia. - While glaucoma can affect the optic disc, spherophakia primarily leads to angle-closure dynamics.

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