Diseases of the Retina — MCQs
On this page
What is the primary cause of exudative retinal detachment?
A 44-year-old woman presents with sudden painless loss of vision with a history of previous similar episodes. Fundoscopy shows no glow. What could be the possible diagnosis?
Most common age related change in vitreous?
Purtscher's retinopathy is associated with -
All of the following are true for sympathetic ophthalmitis except which of the following?
Which cells in the retina are primarily affected by methanol toxicity?
Sudden loss of vision without pain - Which of the following is NOT a cause?
What is the typical appearance of a subhyaloid hemorrhage in the eye?
What is the cause of glaucoma in retinoblastoma?
Which of the following statements is false regarding Eale's disease?
Diseases of the Retina Indian Medical PG Practice Questions and MCQs
Question 541: What is the primary cause of exudative retinal detachment?
- A. Traction on the retina causing detachment.
- B. Retinal tear leading to fluid accumulation.
- C. Fluid accumulation due to Coats' disease.
- D. Inflammation and vascular abnormalities leading to fluid accumulation beneath the retina. (Correct Answer)
Explanation: **Correct Answer: Inflammation and vascular abnormalities leading to fluid accumulation beneath the retina** - **Exudative retinal detachment** occurs when fluid accumulates beneath the retina due to compromised vascular integrity, often from inflammation, tumors, or systemic conditions. - This fluid is rich in protein and inflammatory mediators, leaking from choroidal or retinal vessels. - Common causes include uveitis, posterior scleritis, Vogt-Koyanagi-Harada disease, choroidal tumors, and conditions like central serous chorioretinopathy. *Incorrect: Traction on the retina causing detachment* - This describes **tractional retinal detachment**, where fibrous or fibrovascular membranes pull the retina away from the underlying retinal pigment epithelium. - It is often seen in conditions like **proliferative diabetic retinopathy** or due to prior retinal inflammatory conditions. *Incorrect: Retinal tear leading to fluid accumulation* - This is the primary mechanism of **rhegmatogenous retinal detachment**, where a break in the retina allows liquefied vitreous to pass into the subretinal space. - It is distinct from exudative detachment, which does not involve a retinal break. *Incorrect: Fluid accumulation due to Coats' disease* - While **Coats' disease** does cause exudative retinal detachment due to abnormal retinal vessels and lipid accumulation, it is a *specific disease* causing exudation, not the overarching primary cause of all exudative detachments. - The more general cause for exudative detachment involves **inflammation and vascular abnormalities**, of which Coats' disease is one example.
Question 542: A 44-year-old woman presents with sudden painless loss of vision with a history of previous similar episodes. Fundoscopy shows no glow. What could be the possible diagnosis?
- A. Vitreous Hemorrhage (Correct Answer)
- B. Rhegmatogenous Retinal Detachment
- C. Acute Angle-Closure Glaucoma
- D. Fungal Keratitis
Explanation: ***Vitreous Hemorrhage*** - **Painless vision loss** is a hallmark symptom, and **previous similar episodes** suggest a recurrent condition, characteristic of vitreous hemorrhage from fragile vessels. - The **"no glow"** on fundoscopy indicates that light from the ophthalmoscope is unable to reflect off the retina due to something obstructing the clear media, such as blood in the vitreous cavity. *Rhegmatogenous Retinal Detachment* - While it causes **painless vision loss**, patients often report **floaters** or **flashes of light** preceding the detachment, which are not mentioned here. - Fundoscopy in rhegmatogenous retinal detachment would typically show a **grayish, elevated retina**, often with folds, not a complete loss of red reflex or ''no glow.'' *Acute Angle-Closure Glaucoma* - Characterized by **sudden, severe eye pain**, blurred vision, and often a **red eye** with a fixed, mid-dilated pupil. - Fundoscopy would typically reveal a **cupped optic disc** in advanced stages, but the primary finding is elevated intraocular pressure, with a clear vitreous, thus allowing an initial glow. *Fungal Keratitis* - This is an **infection of the cornea** that typically presents with pain, redness, photophobia, and a visible corneal ulcer or infiltrate. - Vision loss is gradual, and fundoscopy would still show a **normal red reflex** unless the corneal opacity is extremely dense, which is not implied by "no glow."
Question 543: Most common age related change in vitreous?
- A. Anterior vitreous detachment
- B. Vitreous hemorrhage
- C. Vitritis
- D. Posterior vitreous detachment (PVD) (Correct Answer)
Explanation: ***Posterior vitreous detachment (PVD)*** - As we age, the **vitreous body** undergoes liquefaction and shrinkage, leading to its separation from the **retina**, most commonly posteriorly. - This is a very common and usually benign age-related phenomenon, often presenting with **floaters** and **flashes of light**. *Anterior vitreous detachment* - **Anterior vitreous detachment** is much less common than PVD and not typically considered the most frequent age-related change. - It often occurs secondary to **trauma** or specific surgical procedures rather than spontaneous aging alone. *Vitreous hemorrhage* - **Vitreous hemorrhage** is a pathological condition involving bleeding into the vitreous humor, often due to **diabetic retinopathy**, retinal tears, or trauma. - It is not a normal age-related change but a complication of underlying disease. *Vitritis* - **Vitritis** refers to inflammation of the vitreous humor, commonly associated with **uveitis** or infections. - It is an inflammatory disease process, not a physiological age-related degeneration of the vitreous.
Question 544: Purtscher's retinopathy is associated with -
- A. Head trauma (Correct Answer)
- B. Diabetes Mellitus
- C. Wilson's disease
- D. Rheumatoid arthritis
Explanation: ***Head trauma*** - **Purtscher's retinopathy** is a rare occlusive microvasculopathy characterized by sudden vision loss and specific retinal findings, classically associated with **head or chest trauma**. - The condition occurs due to **fat embolization** and **leukoembolization** with complement activation, leading to occlusion of retinal precapillary arterioles. - Classic findings include **cotton wool spots**, intraretinal hemorrhages, and **Purtscher flecken** (polygonal areas of retinal whitening between the optic disc and macula). - The term "Purtscher's retinopathy" specifically refers to trauma-induced cases, while "Purtscher-like retinopathy" describes similar findings from non-traumatic causes (acute pancreatitis, fat embolism syndrome, amniotic fluid embolism). *Diabetes Mellitus* - **Diabetic retinopathy** is associated with chronic hyperglycemia causing microvascular damage, characterized by microaneurysms, dot-blot hemorrhages, hard exudates, and venous beading. - It involves gradual progressive changes over years, not acute embolic occlusion from trauma. - Advanced stages include **proliferative diabetic retinopathy** with neovascularization and diabetic macular edema. *Wilson's disease* - **Wilson's disease** is an autosomal recessive disorder of copper metabolism affecting the liver, brain, and eyes. - Ocular manifestations include **Kayser-Fleischer rings** (copper deposition in Descemet's membrane) and sunflower cataracts. - It does not cause acute retinal vascular occlusion or the specific findings of Purtscher's retinopathy. *Rheumatoid arthritis* - **Rheumatoid arthritis** is a chronic autoimmune inflammatory disease primarily affecting joints. - Ocular manifestations include **keratoconjunctivitis sicca** (dry eyes), **episcleritis**, **scleritis**, and peripheral ulcerative keratitis. - It is not associated with Purtscher's retinopathy, which is specifically linked to traumatic or embolic events.
Question 545: All of the following are true for sympathetic ophthalmitis except which of the following?
- A. Mostly results from a penetrating wound
- B. Autoimmune etiology
- C. Dalen-Fuchs nodules may be seen
- D. Affects the injured eye (Correct Answer)
Explanation: ***Affects the injured eye*** - Sympathetic ophthalmia is a **bilateral, granulomatous panuveitis** that characteristically affects the **fellow, uninjured eye** (sympathizing eye) following trauma or surgery to the other eye (exciting eye). - The disease involves an immune response directed against ocular antigens, typically from the uveal tissue, in the uninjured eye. *Mostly results from a penetrating wound* - This statement is true; **penetrating ocular trauma** (e.g., from surgery or injury) is the most common trigger for sympathetic ophthalmia. - The exposure of uveal antigens from the injured eye initiates an autoimmune response. *Autoimmune etiology* - This statement is true; sympathetic ophthalmia is an **autoimmune disease** mediated by T-lymphocytes against uveal antigens. - The condition is characterized by a delayed hypersensitivity reaction against exposed uveal proteins. *Dalen Fuch's nodules may be seen* - This statement is true; **Dalen-Fuchs nodules** are characteristic histopathological findings in sympathetic ophthalmia. - These are accumulations of epithelioid cells and lymphocytes located between the retinal pigment epithelium and Bruch's membrane.
Question 546: Which cells in the retina are primarily affected by methanol toxicity?
- A. Photoreceptor cells
- B. Bipolar cells
- C. Horizontal cells
- D. Ganglion cells of the retina (Correct Answer)
Explanation: ***Ganglion cells of the retina*** - Methanol toxicity, specifically its metabolite **formic acid**, selectively targets and damages **retinal ganglion cells**. - This damage leads to **optic neuropathy** and can cause permanent vision loss or blindness. *Photoreceptor cells* - These cells (rods and cones) are responsible for light detection but are generally **not primarily affected** by methanol toxicity. - While severe toxicity can lead to widespread retinal damage, initial and primary damage is to the ganglion cells. *Bipolar cells* - Bipolar cells transmit signals from photoreceptors to ganglion cells but are **not the primary target** of methanol's toxic effects. - Their damage would typically be secondary to severe, prolonged methanol poisoning. *Horizontal cells* - Horizontal cells are involved in lateral inhibition and signal processing within the retina but are **not selectively vulnerable** to methanol toxicity. - Damage to these cells is not a defining feature of methanol-induced vision loss.
Question 547: Sudden loss of vision without pain - Which of the following is NOT a cause?
- A. CRAO
- B. CSR
- C. Acute congestive glaucoma (Correct Answer)
- D. Vitreous Hemorrhage
Explanation: ***Acute congestive glaucoma*** - This condition is characterized by **sudden, severe eye pain** along with blurred vision, redness, and a fixed, mid-dilated pupil. - The pain arises from abrupt elevation of **intraocular pressure**, which differentiates it from painless vision loss. *CRAO* - **Central Retinal Artery Occlusion** (CRAO) typically presents as **sudden, profound, painless monocular vision loss**. - Funduscopic examination often reveals a **cherry-red spot** in the fovea with generalized retinal whitening. *CSR* - **Central Serous Retinopathy** (CSR) causes **sudden, painless blurred vision** or a scotoma, often described as a "watery" or "shimmering" effect. - It involves leakage of fluid under the retina, typically in the macula. *Vitreous Hemorrhage* - Presents as **sudden, painless loss of vision** or a shower of floaters, often described as cobwebs or clouds. - It results from bleeding into the **vitreous cavity**, which can obscure the retina.
Question 548: What is the typical appearance of a subhyaloid hemorrhage in the eye?
- A. Boat shaped (Correct Answer)
- B. Crescent shaped
- C. Round
- D. Flame shaped
Explanation: ***Boat shaped*** - A subhyaloid hemorrhage is located beneath the **hyaloid membrane** (the posterior vitreous cortex), which is attached to the retina. - The collected blood often assumes a **dependent, gravity-influenced shape**, appearing flat on top and curved underneath, resembling a boat. *Crescent shaped* - This shape is not characteristic of a typical subhyaloid hemorrhage; it might be seen in other types of hemorrhages or detachment patterns. - **Crescentic shapes** are more commonly associated with certain types of **retinal detachments** or tears where fluid accumulation takes on a curved boundary. *Round* - While hemorrhages can be round, a subhyaloid hemorrhage typically spreads out due to gravity within the confined space, resulting in a more distinct shape. - A **perfectly round hemorrhage** is less common in the subhyaloid space as blood tends to layer out rather than remain as a sphere. *Flame shaped* - **Flame-shaped hemorrhages** are typically found in the **nerve fiber layer** due to the orientation of nerve fibers. - These hemorrhages are shallower and follow the linear arrangement of nerve fibers, unlike the larger, more globular subhyaloid bleeds.
Question 549: What is the cause of glaucoma in retinoblastoma?
- A. Neovascularisation (Correct Answer)
- B. Mass effect of the tumour
- C. Blockage of trabecular network
- D. Lysis of the lens
Explanation: ***Neovascularisation*** - Retinoblastoma leads to **neovascularization of the iris (NVI)** and **angle structures** due to tumor necrosis, ischemia, and release of **angiogenic factors (VEGF)**. - The **neovascular membrane** grows over and obstructs the **trabecular meshwork** and anterior chamber angle, causing **secondary neovascular glaucoma**. - This is the **most characteristic and common mechanism** of glaucoma in advanced retinoblastoma. - Neovascular glaucoma in retinoblastoma is typically **refractory to medical treatment** and indicates poor prognosis. *Blockage of trabecular network* - While tumor cells can directly seed into the anterior chamber and block the trabecular meshwork, this mechanism is **less common** than neovascularization. - This option is also **less specific** as it doesn't identify the underlying pathophysiological process (neovascularization) that is characteristic of retinoblastoma-associated glaucoma. - Direct trabecular blockage by tumor cells typically occurs in advanced disease and often coexists with neovascularization. *Mass effect of the tumour* - The tumor mass itself rarely causes glaucoma through direct mechanical compression of outflow pathways. - Retinoblastoma causes glaucoma primarily through **secondary mechanisms** such as inflammation, neovascularization, or cellular seeding, not simple bulk effect. - Massive tumors may cause angle closure, but this is uncommon compared to neovascular mechanisms. *Lysis of the lens* - **Phacolytic glaucoma** from lens protein leakage is rare in retinoblastoma. - While lens damage can occur with advanced tumors, it is **not a typical or characteristic cause** of glaucoma in retinoblastoma. - The primary mechanisms involve the **tumor-angle-trabecular meshwork axis**, not lens pathology.
Question 550: Which of the following statements is false regarding Eale's disease?
- A. Optic neuritis (Correct Answer)
- B. AKT is given
- C. Vitreous Hemorrhage
- D. Retinal detachment may occur
Explanation: ***Correct Answer: Optic neuritis*** - This statement is **false** because **Eale's disease** is a **peripheral retinal vasculitis** (periphlebitis) that primarily affects the **peripheral retinal veins**. - The condition does **NOT involve the optic nerve**, and **optic neuritis is NOT a recognized feature or complication** of Eale's disease. - The disease process is confined to the retinal vasculature and does not extend anteriorly to involve the optic disc or nerve in typical cases. *AKT is given* - While the exact etiology of Eale's disease remains uncertain, there is a **historical and clinical association with tuberculosis**, particularly in TB-endemic regions like India. - In clinical practice, **anti-tubercular therapy (ATT/AKT) is often empirically administered** when TB cannot be ruled out or when there is suspicion of systemic TB. - Some studies suggest ATT may help reduce inflammation and prevent recurrence in selected cases. *Vitreous Hemorrhage* - This is a **hallmark complication** of Eale's disease, particularly in stage 3 (proliferative stage). - **Recurrent vitreous hemorrhage** occurs due to rupture of fragile neovascular vessels that form in response to retinal ischemia. - It is one of the most common presentations requiring intervention. *Retinal detachment may occur* - **Tractional retinal detachment** is a recognized complication resulting from contraction of **fibrovascular proliferative membranes**. - **Rhegmatogenous retinal detachment** can also occur if vitreoretinal traction causes retinal breaks. - Both types may require surgical intervention (vitrectomy).
Practice by Chapter
Retinal Anatomy and Physiology
Practice Questions
Age-Related Macular Degeneration
Practice Questions
Diabetic Retinopathy
Practice Questions
Retinal Vascular Diseases
Practice Questions
Retinal Detachment
Practice Questions
Hereditary Retinal Dystrophies
Practice Questions
Inflammatory Retinal Diseases
Practice Questions
Retinal Tumors
Practice Questions
Retinopathy of Prematurity
Practice Questions
Retinal Imaging Techniques
Practice Questions
Intravitreal Pharmacotherapy
Practice Questions
Vitreoretinal Surgery
Practice Questions
Want unlimited practice?
Get full access to all questions, explanations, and performance tracking.
Start For Free