Blunt Trauma — MCQs
A 33-year-old patient suffers from blunt trauma to the eye. Fundoscopy shows a cherry red spot, the probable diagnosis is
A patient presents with acute appendicitis. What is NOT to be done?
Following blunt trauma a young male presents with a D shaped pupil. What is the diagnosis?
Secondary glaucoma associated with angle recession is seen in:
Which of the following ophthalmologic conditions shows 'Vossius ring' during examination?
Berlin's edema is due to
Hyphaema, or blood in the anterior chamber, is suggestive of:
A patient sustained blunt trauma to the eye, after which he developed sudden loss of vision with deep anterior chamber. Most likely cause is:
Vossius ring occurs in
Sympathetic ophthalmia is due to
Blunt Trauma Indian Medical PG Practice Questions and MCQs
Question 1: A 33-year-old patient suffers from blunt trauma to the eye. Fundoscopy shows a cherry red spot, the probable diagnosis is
- A. Central Retinal Artery Occlusion (Correct Answer)
- B. Retinoblastoma
- C. Optic nerve transection
- D. Posterior Vitreous Detachment
Explanation: ***Central Retinal Artery Occlusion*** - A **cherry red spot** on fundoscopy is a classic sign of **central retinal artery occlusion (CRAO)**, occurring due to the opaque retina surrounding the fovea, which maintains its blood supply from the choroid. - While blunt trauma can cause CRAO, the primary mechanism is often an **arterial embolism** or thrombus, leading to acute, painless vision loss. *Retinoblastoma* - Retinoblastoma is a **childhood eye cancer** most commonly presenting with **leukocoria** (white pupillary reflex) and strabismus, not typically a cherry red spot. - Although it can present with retinal detachment, the characteristic fundoscopic finding is a **white intraocular mass**, not an ischemic retinal appearance. *Optic nerve transection* - Optic nerve transection results in immediate, severe vision loss and a **positive relative afferent pupillary defect (RAPD)**, but it generally does not cause a cherry red spot. - Fundoscopy after optic nerve transection would initially appear normal, with subsequent **optic disc pallor** developing over weeks to months. *Posterior Vitreous Detachment* - **Posterior vitreous detachment (PVD)** is a common age-related condition presenting with **floaters** and **flashes of light**. - Fundoscopy typically reveals a **Weiss ring** (a ring of glial tissue) and vitreous opacities, not a cherry red spot, and vision loss is often not as sudden or severe as CRAO.
Question 2: A patient presents with acute appendicitis. What is NOT to be done?
- A. Give antibiotics
- B. Do primary survey
- C. Perform appendectomy
- D. Check for visual acuity (Correct Answer)
Explanation: ***Check for visual acuity*** - **Visual acuity** assessment is not relevant to the diagnosis or management of **acute appendicitis**. - This examination is typically performed in cases of suspected eye injury, vision changes, or neurological issues that affect vision. - In the context of acute appendicitis, checking visual acuity would be inappropriate and waste valuable time. *Give antibiotics* - **Antibiotics** are crucial in managing **acute appendicitis** to prevent progression to perforation and reduce postoperative infection risk. - They are typically administered preoperatively and continued postoperatively, especially in cases of complicated appendicitis. - Broad-spectrum antibiotics covering **gram-negative organisms and anaerobes** are standard practice. *Do primary survey* - A **primary survey** (ABCDE approach) is essential in any emergent patient presentation to assess and manage immediate **life-threatening conditions**. - While appendicitis itself may not be immediately life-threatening, ensuring patient stability and ruling out other serious conditions is critical. - This is standard emergency medicine practice and should always be performed. *Perform appendectomy* - **Appendectomy** (surgical removal of the appendix) is the definitive treatment for **acute appendicitis**. - This is the standard of care and should be performed once the diagnosis is confirmed and the patient is stable. - Either open or laparoscopic approach can be used depending on clinical factors and surgeon expertise.
Question 3: Following blunt trauma a young male presents with a D shaped pupil. What is the diagnosis?
- A. Iridodialysis (Correct Answer)
- B. Orbital fracture
- C. Traumatic hyphema
- D. Iridoschisis
Explanation: ***Iridodialysis*** - A **D-shaped pupil** strongly suggests **iridodialysis**, which is a disinsertion of the iris root from the ciliary body. - This typically occurs after **blunt trauma** to the eye, allowing the pupil to be distorted towards the point of detachment. *Orbital fracture* - An orbital fracture often presents with **periorbital ecchymosis**, **diplopia**, **enophthalmos**, or **proptosis**, depending on the fracture location. - While it results from blunt trauma, it doesn't directly cause a D-shaped pupil but can lead to other ocular complications. *Traumatic hyphema* - Traumatic hyphema is characterized by **blood in the anterior chamber** of the eye, which can be visible as a red fluid level. - While caused by blunt trauma, it typically presents with blurred vision and pain, not a D-shaped pupil. *Iridoschisis* - Iridoschisis is a rare condition involving the **splitting of the iris stroma**, usually in the elderly, and is not typically associated with acute trauma or a D-shaped pupil. - It often leads to **fine, detached iris fibers** floating in the anterior chamber, rather than a gross deformation of the pupil.
Question 4: Secondary glaucoma associated with angle recession is seen in:
- A. Penetrating injury
- B. Concussion injury (Correct Answer)
- C. Chemical injury
- D. Radiation injury
Explanation: ***Concussion injury*** - **Concussion injuries** (blunt trauma) to the eye lead to shearing forces between the ciliary body and sclera, causing a tear in the ciliary body and trabecular meshwork. - This anatomical alteration, known as **angle recession**, impairs aqueous humor outflow over time, leading to secondary open-angle glaucoma. *Penetrating injury* - **Penetrating injuries** breach the globe and can cause direct damage to ocular structures, but angle recession leading to glaucoma is more characteristic of blunt trauma. - Such injuries often lead to other forms of glaucoma, like **pupillary block** or **phacolytic glaucoma**, depending on the extent of damage and inflammation. *Chemical injury* - **Chemical injuries** (e.g., acid or alkali burns) cause severe inflammation, tissue necrosis, and scarring within the anterior segment. - Glaucoma following chemical injury is typically due to **trabecular meshwork damage** from inflammation and scarring, or **peripheral anterior synechiae formation**, rather than angle recession. *Radiation injury* - **Radiation injury** to the eye is rare but can occur with radiation therapy for tumors, causing damage to vascular structures and contributing to neovascularization. - Glaucoma associated with radiation injury is usually secondary to **neovascularization** of the angle or **inflammatory processes**, not angle recession.
Question 5: Which of the following ophthalmologic conditions shows 'Vossius ring' during examination?
- A. Angle closure glaucoma
- B. Traumatic iritis (Correct Answer)
- C. Retinal detachment
- D. Corneal ulcer
Explanation: ***Traumatic iritis*** - A **Vossius ring** is a circular pigment deposit on the anterior lens capsule, formed by the impact of the iris during **ocular trauma**. - Its presence is a clear indicator of **blunt globe trauma**, which often leads to traumatic iritis. *Angle closure glaucoma* - This condition involves an **acute increase in intraocular pressure** due to the iris blocking the drainage angle. - While it can cause severe pain and vision loss, it does not involve the formation of a **Vossius ring**. *Retinal detachment* - This condition involves the separation of the sensory retina from the underlying retinal pigment epithelium. - Symptoms include **flashing lights**, **floaters**, and a **"curtain" vision loss**, with no association with a Vossius ring. *Corneal ulcer* - A corneal ulcer is an **open sore on the cornea**, typically caused by infection or injury. - It presents with **pain**, **photophobia**, **redness**, and **discharge**, without the characteristic lens pigment deposit.
Question 6: Berlin's edema is due to
- A. Blunt trauma to eye (Correct Answer)
- B. Choroidal melanoma
- C. Pars planitis
- D. Extradural hemorrhage
Explanation: ***Blunt trauma to eye*** - **Berlin's edema**, also known as **commotio retinae**, is a form of **retinal edema** that occurs after **blunt trauma to the eye**. - The trauma causes a disruption of the photoreceptor outer segments and retinal pigment epithelium, leading to extracellular and intracellular fluid accumulation. *Choroidal melanoma* - This is a **malignant tumor** arising from the melanocytes in the choroid, not caused by trauma. - Presents as a pigmented mass in the choroid and can lead to **retinal detachment** or **vision loss** due to tumor growth. *Pars planitis* - This is a form of **intermediate uveitis**, characterized by inflammation of the pars plana, ciliary body, and peripheral retina. - It is an **inflammatory condition**, not directly caused by acute trauma, and often presents with **floaters** and **blurred vision**. *Extradural hemorrhage* - This refers to bleeding between the inner surface of the skull and the dura mater, typically in the brain. - It is a **neurological emergency** usually caused by head injury, and its direct effect is not Berlin's edema in the eye.
Question 7: Hyphaema, or blood in the anterior chamber, is suggestive of:
- A. Intraocular trauma (Correct Answer)
- B. Posterior uveitis
- C. Capillary hemangioma of the lid
- D. High grade myopia
Explanation: ***Intraocular trauma*** - **Hyphaema**, or blood in the **anterior chamber**, is a classic sign of **intraocular trauma**, where eye structures are damaged, leading to bleeding. - This can result from blunt force or penetrating injuries that rupture blood vessels within the **iris, ciliary body**, or other anterior segment structures. *Posterior uveitis* - Posterior uveitis involves inflammation of the **choroid and retina**, not typically causing bleeding into the **anterior chamber**. - It presents with symptoms like **floaters** and **decreased vision**, without direct hyphaema. *Capillary hemangioma of the lid* - A capillary hemangioma is a **benign vascular tumor** on the eyelid and does not cause **intraocular bleeding** into the anterior chamber. - While it can disrupt vision by blocking the visual axis, it is an **external lesion**. *High grade myopia* - High grade myopia leads to a **stretched globe** and **retinal thinning**, increasing the risk of **retinal detachment** or **macular degeneration**. - It does not directly cause **hyphaema**, which is an anterior chamber bleeding event.
Question 8: A patient sustained blunt trauma to the eye, after which he developed sudden loss of vision with deep anterior chamber. Most likely cause is:
- A. Retinal haemorrhage
- B. Lens dislocation (Correct Answer)
- C. Berlin's oedema
- D. Recession of angle of AC
Explanation: ***Lens dislocation*** - **Blunt trauma** can cause **zonular rupture**, leading to **lens dislocation** into the vitreous or anterior chamber. - A dislocated lens in the vitreous space results in a **deep anterior chamber** and sudden vision loss due to loss of the refractive power of the lens. *Retinal haemorrhage* - While blunt trauma can cause **retinal haemorrhage**, it typically does not present with a **deep anterior chamber**. - Vision loss from retinal haemorrhage depends on its size and location, but it's not directly associated with changes in anterior chamber depth. *Berlin's oedema* - Also known as **commotio retinae**, this condition involves **retinal oedema** due to blunt trauma, causing sudden vision loss. - However, Berlin's oedema is a retinal condition and does not typically alter the **depth of the anterior chamber**. *Recession of angle of AC* - **Angle recession** is a common consequence of blunt trauma, where the ciliary body detaches from the scleral spur, causing a widening of the **anterior chamber angle**. - While it can lead to **secondary glaucoma** over time, it typically does not cause **sudden profound vision loss** immediately after trauma and does not necessarily result in a *deep* anterior chamber.
Question 9: Vossius ring occurs in
- A. Lens dislocation
- B. Concussion injury (Correct Answer)
- C. Penetrating injury
- D. Extra capsular extraction
Explanation: ***Concussion injury*** - A Vossius ring is a circular deposit of **iris pigment** on the anterior lens capsule, formed by direct contact between the iris and the lens following **blunt ocular trauma**. - This typically occurs during a **concussion injury** to the eye, where the force temporarily compresses the iris against the lens. *Lens dislocation* - While lens dislocation is also a traumatic injury, a Vossius ring is not a direct consequence but rather a separate finding. - Lens dislocation involves the displacement of the **lens from its normal position**, often due to rupture of zonular fibers. *Penetrating injury* - A penetrating injury involves a **breach of the globe's integrity**, often by a sharp object, leading to different sequelae such as uveal prolapse or traumatic cataract. - Vossius rings are characteristic of **blunt trauma**, not penetrating trauma. *Extra capsular extraction* - Extracapsular extraction is a surgical procedure for **cataract removal**, not a type of injury. - This procedure involves removing the lens nucleus and cortex while leaving the posterior capsule intact.
Question 10: Sympathetic ophthalmia is due to
- A. Chemical injury
- B. Blunt trauma
- C. Retained intra ocular Iron foreign body
- D. Penetrating trauma (Correct Answer)
Explanation: ***Penetrating trauma*** - **Sympathetic ophthalmia** is a rare, bilateral granulomatous panuveitis that occurs after **penetrating trauma** or surgery to one eye (the exciting eye). - The injury exposes **uveal antigens** to the immune system, leading to a delayed hypersensitivity reaction affecting both the injured and the uninjured (sympathizing) eye. *Chemical injury* - Chemical injuries to the eye typically cause corneal damage, conjunctivitis, and uveitis, but do not commonly lead to the bilateral immune response characteristic of **sympathetic ophthalmia**. - The mechanism of injury in chemical trauma does not involve the exposure of hidden ocular antigens in a way that triggers **autoimmune uveitis**. *Blunt trauma* - **Blunt trauma** to the eye can cause various issues like hyphema, retinal detachment, or orbital fractures. - While it can cause significant damage, it generally does not typically breach the globe in a manner that exposes uveal tissue to the systemic immune system, leading to **sympathetic ophthalmia**. *Retained intra ocular Iron foreign body* - An intraocular **iron foreign body** can cause **siderosis bulbi**, a condition where iron deposition leads to pigmentation and degeneration of ocular tissues. - This is a direct toxic effect of iron and is distinct from the immune-mediated inflammation seen in **sympathetic ophthalmia**.
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