Diseases of the Retina Practice Questions

Q: 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?

Diabetic retinopathy. ***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.

Q: True about hydroxychloroquine retinopathy EXCEPT:

Reversible on stopping drug. ***Reversible on stopping drug*** - **Hydroxychloroquine retinopathy** is generally **irreversible**, even after discontinuing the drug, and can progress after cessation. - The damage to the **retinal pigment epithelium** and photoreceptors is permanent, leading to irreversible vision loss. *Cumulative dose dependent* - The risk of hydroxychloroquine retinopathy is strongly associated with the **cumulative dose** and duration of treatment. - This underscores the importance of monitoring total dosage over time to assess risk. *Bull's eye maculopathy* - **Bull's eye maculopathy** is a classic and late-stage ophthalmoscopic finding in hydroxychloroquine retinopathy. - It involves a ring of **retinal pigment epithelium atrophy** surrounding an intact fovea. *Regular screening needed* - Due to the potential for irreversible vision loss and the cumulative dose-dependent risk, **regular ophthalmic screening** is crucial for patients on hydroxychloroquine. - Screening typically includes visual field testing, **spectral-domain optical coherence tomography (SD-OCT)**, and fundus autofluorescence.

Q: Following are the causes of sudden loss of vision except?

Corneal ulceration. ***Corneal ulceration*** - While a corneal ulcer can cause significant pain, redness, and some vision loss, it typically leads to a **gradual decrease in vision** over days, rather than a sudden, profound loss. - The vision loss associated with corneal ulceration is usually due to **stromal edema** and scarring, which develop progressively. *Endophthalmitis* - This is a severe inflammation of the intraocular fluids (vitreous and aqueous humor), often due to infection, which can lead to a **rapid and severe loss of vision**. - It often presents with **pain, red eye, and hypopyon**, alongside sudden vision changes. *Angle closure glaucoma* - An acute attack of angle closure glaucoma results in a **sudden increase in intraocular pressure**, causing rapid onset of **pain, headache, blurred vision, and halos around lights**. - This high pressure quickly damages the optic nerve, leading to **sudden vision loss** if not treated promptly. *Central serous retinopathy* - This condition involves fluid accumulation under the retina, causing a **sudden onset of blurred or distorted vision** (metamorphopsia) in the central visual field. - Patients often experience a **scotoma** (blind spot) and perceive objects as smaller (micropsia) or further away.

Q: A patient with hypertension and diabetes presents with blurred vision. Fluorescein angiography shows the following findings. What is the diagnosis?

Macular edema. ***Macular edema*** - The fluorescein angiography (B and D) shows areas of **hyperfluorescence** and **leakage** in the macula, indicative of **macular edema**, a common complication in patients with hypertension and diabetes. - The presence of **hard exudates** and diffuse leakage observed in the image are characteristic findings of diabetic macular edema, leading to blurred vision. *Sub macular edema* - Submacular edema refers to fluid accumulation **beneath the macula**, which would typically manifest differently on fluorescein angiography, often as a distinct pooling. - While fluid can accumulate in the macula, the diffuse leakage pattern shown here is more consistent with intraretinal accumulation characteristic of general macular edema. *Pre macular hemorrhage* - A premacular hemorrhage would appear as a **dark, non-perfused area** on fluorescein angiography due to the blocking effect of blood anterior to the retina. - The images provided show **leakage and hyperfluorescence**, not a blockage from hemorrhage. *Papilledema* - **Papilledema** is swelling of the optic disc due to increased intracranial pressure, characterized by blurred optic disc margins and elevation. - The images show pathology primarily affecting the **macular region** with clear optic disc margins, ruling out papilledema.

Q: What is a characteristic fundoscopic finding in advanced hypertensive retinopathy?

Cotton wool spots. ***Cotton wool spots*** - These are **soft exudates** that represent **acute focal infarction of the retinal nerve fiber layer** due to severe hypertension, indicating advanced hypertensive retinopathy (Grade III-IV). - They appear as **fluffy, white patches** with irregular, feathery borders in the superficial retina, caused by **ischemia and disruption of axoplasmic flow**. - In Grade IV (malignant hypertension), **optic disc edema** may also be present alongside cotton wool spots. *Microaneurysms* - These are small, dot-like hemorrhages common in **diabetic retinopathy**, resulting from weakened capillary walls. - While hypertension can coexist with diabetes and exacerbate retinal changes, **microaneurysms** are not a primary, characteristic finding of hypertensive retinopathy itself. *Cherry-red spot* - A **cherry-red spot** is a classic finding in **central retinal artery occlusion (CRAO)** and **Tay-Sachs disease**, due to the transparent fovea allowing visualization of the underlying choroidal circulation. - It does not characterize hypertensive retinopathy. *Drusen* - **Drusen** are yellow deposits under the retina, primarily associated with **age-related macular degeneration (AMD)**. - They are not a feature of hypertensive retinopathy.

Q: A 30-year-old female presents with night blindness and peripheral vision loss. Likely diagnosis?

Retinitis pigmentosa. ***Retinitis pigmentosa*** - This condition is characterized by **progressive degeneration of photoreceptor cells**, particularly **rods**, leading to **night blindness (nyctalopia)** and gradual **peripheral vision loss**. - Often leads to a characteristic **'tunnel vision'** due to the progressive loss of the outer visual field. *Macular degeneration* - Primarily affects **central vision**, leading to difficulty with tasks like reading and recognizing faces, rather than night blindness or peripheral loss. - It involves the **degeneration of the macula**, which is responsible for sharp, detailed central vision. *Glaucoma* - Causes gradual **peripheral vision loss** and can lead to **tunnel vision**, but typically does not cause night blindness as its primary symptom. - Results from **damage to the optic nerve**, often due to increased intraocular pressure. *Cataract* - Causes **clouding of the eye's natural lens**, leading to blurry vision, glare, and dulled colors. - It does not typically present with specific night blindness or peripheral vision loss but rather a general decrease in visual acuity.

Q: A patient presents with a central scotoma and metamorphopsia. What is the most likely cause?

Macular degeneration. ***Macular degeneration*** - **Central scotoma** and **metamorphopsia** are classic symptoms of macular degeneration, indicating damage to the macula which is responsible for central and detailed vision. - **Metamorphopsia** refers to distorted vision, where straight lines appear wavy, and is a key indicator of macular involvement. *Retinal detachment* - While a significant eye condition, **retinal detachment** typically presents with symptoms like a sudden increase in **floaters**, flashes of light (photopsia), and a "curtain" coming across the field of vision, not primarily central scotoma and metamorphopsia. - It involves the separation of the sensory retina from the underlying retinal pigment epithelium, causing peripheral visual field loss initially, which can progress to central loss if the macula becomes detached. *Glaucoma* - **Glaucoma** is characterized by progressive optic nerve damage, often associated with increased intraocular pressure. - It typically leads to **peripheral vision loss** first, often described as tunnel vision, and usually does not cause metamorphopsia or a central scotoma until very late stages. *Optic neuritis* - **Optic neuritis** involves inflammation of the optic nerve, leading to sudden, often painful, vision loss in one eye and a **central scotoma**. - However, it typically does not cause **metamorphopsia**, which is more specific to macular pathology.

Q: A patient presents with superior quadrant vision loss since one week. Patient has Rheumatic Heart Disease (RHD) and is not taking medications. What is the most likely diagnosis?

BRAO. ***BRAO*** - **Branch retinal artery occlusion** (BRAO) presents with **sudden, painless sectoral or quadrant visual field loss** corresponding to the distribution of the occluded arterial branch. - Superior quadrant vision loss indicates **inferior retinal involvement** (visual field is inverted on retina). - **Rheumatic heart disease** not on anticoagulation poses high risk for **cardiac emboli** from valvular vegetations or atrial fibrillation, which preferentially cause **arterial occlusions** (BRAO/CRAO). - Fundoscopy shows **retinal whitening** in the affected area with a clear demarcation line. *BRVO* - **Branch retinal vein occlusion** causes quadrant vision loss but is **NOT typically embolic** in nature. - BRVO is associated with systemic **vascular risk factors** (hypertension, diabetes, hyperlipidemia), not cardiac emboli. - Fundoscopy shows **flame-shaped hemorrhages** and cotton-wool spots in a wedge distribution. *CRAO* - **Central retinal artery occlusion** presents with **complete, sudden painless monocular vision loss** affecting the entire visual field. - Shows classic **"cherry-red spot"** at the fovea due to diffuse retinal ischemia. - Would not present with isolated quadrant vision loss. *CRVO* - **Central retinal vein occlusion** causes **complete monocular vision loss** with "blood and thunder" appearance on fundoscopy. - Presents with diffuse retinal hemorrhages throughout the retina, not isolated to one quadrant.

Q: A 40-year-old male experiences flashes of light. Which of the following can likely be the reason?

Retinal detachment. ***Retinal detachment*** - Flashes of light, or **photopsia**, are a classic symptom of **retinal detachment**, often caused by the retina pulling away from the underlying choroid. - This sensation occurs as the detached retina is mechanically stimulated, sending abnormal signals to the brain that are interpreted as light flashes. *CRAO* - **Central Retinal Artery Occlusion (CRAO)** typically presents with **sudden, painless, severe vision loss** in one eye, not flashes of light. - The primary pathology is a blockage of blood flow to the retina, leading to **ischemia** and vision impairment. *SAH* - **Subarachnoid Hemorrhage (SAH)** is a neurological emergency characterized by **sudden, severe headache** (thunderclap headache), stiff neck, and altered mental status. - While it can cause visual disturbances, these are usually **diplopia** or **visual field defects** due to cranial nerve involvement, not flashes of light related to retinal pathology. *Branch retinal artery occlusion* - **Branch Retinal Artery Occlusion** causes **sudden, painless vision loss** in a specific part of the visual field corresponding to the occluded branch. - Like CRAO, it is an ischemic event and does not typically present with flashes of light; instead, it results in a **scotoma** or partial vision loss.

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?

Accepted Answer

Diabetic retinopathy

Answer

Hypertensive retinopathy

Answer

CRAO

Answer

CRVO

Question 2

True about hydroxychloroquine retinopathy EXCEPT:

Accepted Answer

Reversible on stopping drug

Answer

Cumulative dose dependent

Answer

Bull's eye maculopathy

Answer

Regular screening needed

Question 3

Following are the causes of sudden loss of vision except?

Accepted Answer

Corneal ulceration

Answer

Endophthalmitis

Answer

Angle closure glaucoma

Answer

Central serous retinopathy

Question 4

A patient with hypertension and diabetes presents with blurred vision. Fluorescein angiography shows the following findings. What is the diagnosis?

Accepted Answer

Macular edema

Answer

Submacular edema

Answer

Premacular hemorrhage

Answer

Papilledema

Question 5

What is a characteristic fundoscopic finding in advanced hypertensive retinopathy?

Accepted Answer

Cotton wool spots

Answer

Microaneurysms

Answer

Cherry-red spot

Answer

Drusen

Question 6

A 30-year-old female presents with night blindness and peripheral vision loss. Likely diagnosis?

Accepted Answer

Retinitis pigmentosa

Answer

Macular degeneration

Answer

Glaucoma

Answer

Cataract

Question 7

Assertion: Myopia is a risk factor for retinal detachment. Reason: In myopia, the axial length of the eye increases, causing the retina to thin and become more prone to detachment.

Accepted Answer

Both Assertion and Reason are true, and Reason is the correct explanation for Assertion.

Answer

Both Assertion and Reason are false.

Answer

Assertion is true, but Reason is false.

Answer

Both Assertion and Reason are true, but Reason is not the correct explanation for Assertion.

Question 8

A patient presents with a central scotoma and metamorphopsia. What is the most likely cause?

Accepted Answer

Macular degeneration

Answer

Retinal detachment

Answer

Glaucoma

Answer

Optic neuritis

Question 9

A patient presents with superior quadrant vision loss since one week. Patient has Rheumatic Heart Disease (RHD) and is not taking medications. What is the most likely diagnosis?

Accepted Answer

BRAO

Answer

CRAO

Answer

CRVO

Answer

BRVO

Question 10

A 40-year-old male experiences flashes of light. Which of the following can likely be the reason?

Accepted Answer

Retinal detachment

Answer

CRAO

Answer

SAH

Answer

Branch retinal artery occlusion

Diseases of the Retina — MCQs

Diseases of the Retina — MCQs

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