Diseases of the Retina Practice Questions

Q: Which of the following findings is indicative of active anterior uveitis?

Cells in anterior chamber. ***Cells in anterior chamber*** - The presence of **inflammatory cells** (leukocytes) in the anterior chamber, visualized on slit-lamp examination with focused beam, is the **primary and most definitive indicator** of active anterior uveitis. - These cells result from breakdown of the **blood-aqueous barrier**, allowing inflammatory cells to enter the aqueous humor. - **Grading of cells** (0 to 4+) helps assess severity and monitor treatment response, making this the gold standard for diagnosing active inflammation. *Keratic precipitate* - **Keratic precipitates (KPs)** are deposits of inflammatory cells on the corneal endothelium (posterior corneal surface). - **Fresh KPs** can indicate active inflammation, but they represent a secondary finding—cells that have adhered to the endothelium. - **Old or pigmented KPs** indicate past inflammation rather than current activity. - The presence of **free-floating cells in the anterior chamber** is a more direct and reliable indicator of active disease than KPs. *Circumcorneal congestion* - **Ciliary flush** (circumcorneal congestion) indicates ocular inflammation but is **non-specific**. - It can be seen in various conditions including **acute angle-closure glaucoma**, **keratitis**, **scleritis**, and **iridocyclitis**. - While supportive of the diagnosis, it does not confirm active cellular inflammation. *Corneal edema* - **Corneal edema** typically results from elevated **intraocular pressure** or endothelial dysfunction. - While it can be a complication of severe or chronic uveitis (especially with secondary glaucoma), it is **not a direct indicator** of active anterior chamber inflammation. - It represents a secondary effect rather than a primary inflammatory sign.

Q: Birdshot retinopathy is characterized by all except?

Unilateral. ***Unilateral*** - **Birdshot retinopathy** is characteristically a **bilateral** inflammatory condition affecting both eyes, even if the onset may be asymmetric. - The disease involves widespread inflammation of the **choroid** and **retina**, typically presenting in both eyes simultaneously or sequentially. - Unilateral presentation would be highly atypical and should prompt consideration of alternative diagnoses. *Common in females* - Birdshot retinopathy shows a **clear female predominance**, with approximately **2-3 times more females affected than males** (60-75% of cases). - This demographic trend is a well-established feature of the disease. - However, it does occur in both sexes and is still considered characteristic of the condition. *HLA-A29 positive* - A strong association with the **HLA-A29 allele** is a hallmark of birdshot retinopathy, found in **over 95% of affected individuals**. - This genetic marker is highly specific and often used to support the diagnosis. - HLA-A29 testing is considered part of the diagnostic workup. *Creamy yellow spots* - The presence of characteristic **creamy yellow-white choroidal lesions**, resembling birdshot scatter, is a defining clinical feature. - These lesions are typically located in the **mid-peripheral and posterior fundus**, distributed radially around the optic disc. - The "birdshot" appearance refers to the scattered pattern resembling shotgun pellet distribution.

Q: Which of the following is NOT a feature of CMV retinitis?

Cracked mud appearance. ***Cracked mud appearance*** - **"Cracked mud appearance"** is not a term used to describe CMV retinitis. The classic descriptions include **"pizza pie"**, **"cottage cheese and ketchup"**, and **"brush-fire"** appearances. - CMV retinitis presents with **necrotizing retinitis** with hemorrhages and granular opacification, not a cracked or atrophic pattern. - This option describes a **non-existent finding** in the context of CMV retinitis. *Immunosuppression* - **Immunosuppression**, especially due to **HIV/AIDS** (CD4 count <50 cells/μL), organ transplantation, or chemotherapy, is a **primary risk factor** for CMV retinitis. - It is crucial for the **reactivation** of latent CMV infection, leading to opportunistic disease. - While technically a predisposing condition rather than a "feature" of the disease itself, it is strongly associated with CMV retinitis. *Brush-fire appearance* - The **"brush-fire appearance"** is a classic description of CMV retinitis, referring to the **active leading edge** of the infection with confluent areas of necrosis and hemorrhage spreading across the retina. - This term captures the **fulminant necrotizing retinitis** with yellow-white retinal opacification and hemorrhages. *Perivasculitis* - **Perivasculitis**, or inflammation around the retinal blood vessels, is a **characteristic pathological feature** of CMV retinitis. - It often manifests as **frosted branch angiitis** (white sheathing around retinal vessels), which can be seen in severe cases.

Q: Which of the following conditions is NOT diagnosed by fluorescein angiography?

Hypertensive retinopathy. ***Hypertensive retinopathy*** - This condition is primarily diagnosed by **clinical fundoscopic examination**, not fluorescein angiography - Diagnosis is based on characteristic clinical findings: **arteriovenous nicking, copper/silver wire arterioles, cotton-wool spots, flame-shaped hemorrhages, and papilledema** in severe cases - **Fluorescein angiography** is rarely needed and only used in research settings or to assess severe complications; it is **not a standard diagnostic tool** for hypertensive retinopathy *Diabetic retinopathy* - **Fluorescein angiography** is extensively used for diagnosing and staging diabetic retinopathy - It helps identify **microaneurysms, capillary non-perfusion areas, macular edema, and neovascularization** - Essential for detecting **proliferative diabetic retinopathy** and planning laser photocoagulation *Central serous retinopathy* - **Fluorescein angiography** shows characteristic **"smokestack" or "inkblot" pattern** of leakage at the RPE level - Demonstrates one or more **leakage points** with progressive pooling of dye in the subretinal space - While **OCT** is now preferred for initial diagnosis, FA remains valuable for identifying leakage sites and guiding treatment *Choroidal neovascularization* - **Fluorescein angiography** is the gold standard for diagnosing **choroidal neovascularization (CNV)** - Shows **early hyperfluorescence with progressive leakage** from abnormal vessels - Critical for determining the **type (classic vs occult), location, and extent** of CNV for treatment planning

Q: Which of the following statements about the c-wave in electroretinogram (ERG) is most accurate?

The 'c' wave is a slow positive wave.. ***The 'c' wave is a slow positive wave.*** - The **c-wave** in an ERG is generated by the **retinal pigment epithelium (RPE)** and is characterized by its **slow, positive deflection**. - It reflects the **hyperpolarization** of the RPE cells in response to light stimulation. *The 'c' wave is a negative wave.* - This statement is incorrect because the **c-wave** is consistently observed as a **positive deflection** in the ERG tracing. - A negative wave like the **a-wave** is generated by photoreceptor hyperpolarization, which is a different component. *The 'b' wave arises primarily from photoreceptors.* - The **b-wave** primarily arises from the **Müller cells** and **bipolar cells**, not directly from photoreceptors. - Photoreceptor activity is primarily reflected in the **a-wave**. *The 'a' wave is a positive wave.* - The **a-wave** is a **negative deflection** in the ERG, representing the **hyperpolarization of photoreceptors** in response to light. - It is the earliest component of the ERG waveform.

Q: What is the primary goal in retinal detachment surgery?

Drainage of subretinal fluid. ***Drainage of subretinal fluid*** - The primary goal in retinal detachment surgery is to reattach the retina by draining the **subretinal fluid** that separates the neural retina from the underlying retinal pigment epithelium (RPE). - This fluid accumulation is what causes the retina to detach, so its removal is crucial for successful reattachment. *Removal of vitreous* - While a **vitrectomy** (removal of vitreous) is often performed in some types of retinal detachment surgery (e.g., rhegmatogenous or tractional detachments), it is a *means* to an end, not the primary goal itself. - The purpose of vitrectomy is often to relieve **vitreous traction** on the retina or to clear media opacities, allowing better access to the underlying retina for repair. *To relieve traction on the retina* - Relieving **traction on the retina** is an important *component* of many retinal detachment surgeries, especially in **tractional retinal detachments** or when vitreous traction exacerbates a rhegmatogenous detachment. - However, the ultimate aim of relieving traction is to allow the retina to flatten and reattach, which inherently involves addressing the subretinal fluid that keeps it detached. *Encirclage* - **Encirclage**, or scleral buckling, is a surgical technique used to indent the sclera and choroid, thereby reducing the vitreous traction and bringing the RPE closer to the detached retina. - While it is a common procedure for retinal detachment, it is a *method* of repair rather than the overarching primary goal itself, which remains the reattachment of the retina by resolving the fluid separation.

Q: Parachute lesions are associated with which of the following conditions?

Eale's disease. ***Eale's disease*** - **Eale's disease** is an idiopathic retinal perivasculitis affecting young males, characterized by recurrent vitreous hemorrhages. - In the context of this question (NEET-2013), the term "parachute lesions" refers to the characteristic pattern of hemorrhages seen in Eale's disease. - The disease features retinal periphlebitis, capillary non-perfusion, and neovascularization leading to vitreous hemorrhage. - **Note:** The term "parachute hemorrhages" in broader ophthalmology typically describes preretinal/subhyaloid hemorrhages that settle inferiorly (boat-shaped), more commonly seen in proliferative diabetic retinopathy. *Diabetes* - **Diabetic retinopathy** presents with microaneurysms, dot-blot hemorrhages, hard exudates, cotton-wool spots, and neovascularization. - While proliferative diabetic retinopathy can cause preretinal "parachute-shaped" hemorrhages (boat-shaped hemorrhages that settle inferiorly), this is not the association being tested in this NEET-2013 question. - The specific context of this exam question associates the term with Eale's disease. *Sickle cell anemia* - **Sickle cell retinopathy** features characteristic sea-fan neovascularization in the peripheral retina. - Can cause salmon-patch hemorrhages, black sunburst lesions, and angioid streaks. - While vitreous hemorrhage can occur, "parachute lesions" is not standard terminology for sickle cell retinopathy manifestations. *None of the options* - This option is incorrect because **Eale's disease** is the correct answer according to the NEET-2013 exam key.

Q: Retinal detachment occurs between which layers of the retina?

Neurosensory retina and retinal pigment epithelium. ***Neurosensory retina and retinal pigment epithelium*** * Retinal detachment most commonly occurs when the **neurosensory retina** separates from the underlying **retinal pigment epithelium (RPE)**. * This separation creates a potential space where fluid can accumulate, leading to vision loss as the photoreceptors are no longer supplied by the RPE. * *Retinal pigment epithelium and choroid* * The **RPE** is firmly attached to the underlying **Bruch's membrane** and the **choroid**, making a detachment at this interface extremely rare. * This type of separation would involve a much deeper defect like a choroidal detachment from the sclera. * *Neurosensory retina and choroid* * This option describes two layers that are separated by the **retinal pigment epithelium (RPE)**, so a direct detachment between them is anatomically incorrect. * The RPE acts as a crucial barrier and functional unit between the neurosensory retina and the choroid. * *None of the options* * This is incorrect as the primary site of retinal detachment is clearly defined anatomically. * The separation between the neurosensory retina and the RPE is the hallmark of most retinal detachments.

Q: Retinitis pigmentosa is characterized by ?

Loss of peripheral vision. ***Loss of peripheral vision*** - Retinitis pigmentosa is a group of genetic disorders that cause **progressive degeneration of photoreceptor cells**, primarily rods, which are concentrated in the periphery of the retina. - This degeneration leads to a gradual **loss of peripheral vision**, often beginning with **night blindness** and progressing to tunnel vision. *Loss of central vision* - Loss of central vision is characteristic of conditions affecting the **macula**, such as **age-related macular degeneration** or certain forms of **macular dystrophy**. - While later stages of retinitis pigmentosa can affect central vision, the initial and primary characteristic is loss of peripheral vision. *Tubular vision* - **Tubular vision** is an advanced stage of peripheral vision loss, where the visual field shrinks to a narrow central area, resembling looking through a tube. - While it can be a consequence of retinitis pigmentosa, it is a description of the **extent of visual field constriction** rather than the primary characteristic of the disease itself. *Visual field constriction* - **Visual field constriction** is a general term for any reduction in the extent of the visual field. - While retinitis pigmentosa certainly causes visual field constriction, the term "loss of peripheral vision" is more specific to the initial and dominant pattern of vision loss in this condition.

Question 1

Which of the following findings is indicative of active anterior uveitis?

Accepted Answer

Cells in anterior chamber

Answer

Circumcorneal congestion

Answer

Keratic precipitate

Answer

Corneal edema

Question 2

Birdshot retinopathy is characterized by all except?

Accepted Answer

Unilateral

Answer

Common in females

Answer

Creamy yellow spots

Answer

HLA-A29 positive

Question 3

Which of the following is NOT a feature of CMV retinitis?

Accepted Answer

Cracked mud appearance

Answer

Perivasculitis

Answer

Brush-fire appearance

Answer

Immunosuppression

Question 4

Which of the following conditions is NOT diagnosed by fluorescein angiography?

Accepted Answer

Hypertensive retinopathy

Answer

Diabetes retinopathy

Answer

Central serous retinopathy

Answer

Choroidal neovascularization

Question 5

Which of the following statements about the c-wave in electroretinogram (ERG) is most accurate?

Accepted Answer

The 'c' wave is a slow positive wave.

Answer

The 'c' wave is a negative wave.

Answer

The 'b' wave arises primarily from photoreceptors.

Answer

The 'a' wave is a positive wave.

Question 6

What is the primary goal in retinal detachment surgery?

Accepted Answer

Drainage of subretinal fluid

Answer

Encirclage

Answer

Removal of vitreous

Answer

To relieve traction on the retina

Question 7

Parachute lesions are associated with which of the following conditions?

Accepted Answer

Eale's disease

Answer

Diabetes

Answer

Sickle cell anemia

Answer

None of the options

Question 8

Retinal detachment occurs between which layers of the retina?

Accepted Answer

Neurosensory retina and retinal pigment epithelium

Answer

Retinal pigment epithelium and choroid

Answer

Neurosensory retina and choroid

Answer

None of the options

Question 9

Which of the following is not considered an ophthalmological emergency?

Accepted Answer

CRVO

Answer

CRAO

Answer

Acute congestive glaucoma

Answer

Endophthalmitis

Question 10

Retinitis pigmentosa is characterized by ?

Accepted Answer

Loss of peripheral vision

Answer

Loss of central vision

Answer

Visual field constriction

Answer

Tubular vision

Diseases of the Retina — MCQs

Diseases of the Retina — MCQs

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