Diseases of the Retina Practice Questions

Q: Which of the following is not a cause of exudative retinal detachment?

High myopia. ***High myopia*** - **High myopia** is a risk factor for **rhegmatogenous retinal detachment**, which is caused by a retinal break, not by fluid accumulation from a vascular or inflammatory process. - In rhegmatogenous detachment, vitreous fluid passes through the break into the subretinal space, separating the **neurosensory retina** from the **retinal pigment epithelium**. *Toxemia of pregnancy* - **Toxemia of pregnancy** (preeclampsia/eclampsia) can cause **exudative retinal detachment** due to choroidal ischemia and dysfunction of the retinal pigment epithelium, leading to fluid leakage. - The elevated **blood pressure** and systemic vascular changes impair choroidal perfusion, resulting in serous fluid accumulation beneath the retina. *Scleritis* - **Posterior scleritis** can lead to **exudative retinal detachment** by causing inflammation and edema of the choroid and sclera, which in turn compromises the integrity of the retinal pigment epithelium. - The inflammatory process increases vascular permeability, allowing fluid to leak into the subretinal space. *Central serous retinopathy* - **Central serous retinopathy** is a classic example of **exudative retinal detachment**, characterized by serous fluid accumulation under the macula. - This occurs due to dysfunction or a break in the **retinal pigment epithelium**, often associated with stress and corticosteroid use, leading to fluid leakage from the choroid.

Q: Which of the following is NOT a characteristic of non-proliferative diabetic retinopathy?

Neovascularization. ***Neovascularization (Correct Answer)*** - **Neovascularization** is the growth of new, abnormal blood vessels and is a defining characteristic of **proliferative diabetic retinopathy**, not non-proliferative. - These fragile new vessels can bleed, leading to **vitreous hemorrhage** or retinal detachment, which are severe complications. *Microaneurysm (Incorrect)* - **Microaneurysms** are characteristic of **non-proliferative diabetic retinopathy**, appearing as small, red dots on the retina due to outpouchings of capillary walls. - They are often the **earliest clinically detectable sign** of diabetic retinopathy. *Hard exudates (Incorrect)* - **Hard exudates** are yellowish-white deposits in the retina, indicative of **non-proliferative diabetic retinopathy**, often due to leakage from damaged capillaries. - They represent **lipid and protein leakage** from incompetent retinal capillaries. *Macular edema (Incorrect)* - **Macular edema** is a common complication in both non-proliferative and proliferative stages, characterized by fluid accumulation in the **macula**. - It results from **leakage from damaged blood vessels** and is the most common cause of vision loss in diabetic retinopathy.

Q: What condition is characterized by an "umbrella" configuration on fluorescein angiography?

Central serous retinopathy. ***Central serous retinopathy*** - The "umbrella" or "smokestack" configuration on **fluorescein angiography** is a classic finding in central serous retinopathy, indicating leakage of dye creating a mushroom-shaped plume. - This leakage originates from the **retinal pigment epithelium (RPE)** into the subretinal space, causing serous detachment of the neurosensory retina. *Retinitis pigmentosa* - Characterized by **progressive photoreceptor degeneration** and **pigmentary changes** in the retina, often described as "bone-spicule" pigmentation. - Fluorescein angiography in retinitis pigmentosa typically shows **atrophy** and **window defects**, not an umbrella pattern of leakage. *Rhegmatogenous retinal detachment* - Involves a **full-thickness break in the retina** that allows vitreous fluid to pass into the subretinal space, causing the retina to detach. - Fluorescein angiography is generally not used for primary diagnosis and would not show an umbrella pattern, but rather **non-perfusion** or vascular changes in the detached area. *Eale's disease* - A rare **idiopathic obliterative periphlebitis** primarily affecting the retinal veins, leading to recurrent vitreous hemorrhages and retinal neovascularization. - Fluorescein angiography would reveal **vascular sheathing**, **non-perfusion**, and **neovascularization**, which are distinct from the umbrella configuration.

Q: The most common cause of vitreous hemorrhage in adults is

Diabetes. ***Diabetes*** - **Proliferative diabetic retinopathy (PDR)** leads to the formation of new, fragile blood vessels (neovascularization) on the retinal surface or optic disc. - These new vessels are prone to bleeding into the **vitreous cavity**, making diabetes the most common cause of vitreous hemorrhage in adults. *Retinal hole* - A retinal hole or tear can lead to **rhegmatogenous retinal detachment** but does not commonly cause significant vitreous hemorrhage on its own. - While a tear can sometimes be associated with a small amount of hemorrhage, it is not the MOST common cause of widespread vitreous bleeding. *Trauma* - **Ocular trauma**, such as blunt or penetrating injuries, can certainly cause vitreous hemorrhage due to direct damage to retinal or choroidal blood vessels. - However, in the general adult population, **systemic diseases** like diabetes are statistically more frequent causes of spontaneous vitreous hemorrhage than acute trauma. *Hypertension* - Severe **hypertensive retinopathy** can cause retinal hemorrhages, microaneurysms, and cotton wool spots, but it typically does not lead to large-volume vitreous hemorrhage. - While hypertension can contribute to the severity of other retinal conditions, it is not the primary direct cause of vitreous hemorrhage itself.

Q: The earliest change noticed in hypertensive retinopathy is:

Arteriolar spasm. ***Arteriolar spasm*** - **Arteriolar spasm** is the **earliest functional change** and is characterized by increased vascular tone in response to elevated blood pressure. - This spasm is a dynamic process and often leads to **narrowing of the retinal arterioles**, which can be observed during fundoscopic examination. *Soft exudate* - **Soft exudates**, also known as **cotton wool spots**, represent areas of **ischemic retinal nerve fiber layer** damage due to obstruction of precapillary arterioles. - These are typically seen in later stages of hypertensive retinopathy, indicating more significant vascular damage and ischemia. *Venospasm* - **Venospasm**, or narrowing of retinal veins, is **not a primary or early finding** in hypertensive retinopathy. - While venous changes like tortuosity can occur, arterial changes dominate the early pathogenesis. *Hard exudate* - **Hard exudates** are yellow-white deposits of **lipid and protein** that leak from damaged capillaries, often indicative of chronic retinal edema and incompetent blood-retinal barrier. - These usually appear in **more advanced stages** of hypertensive retinopathy and are not considered the earliest change.

Q: Snow banking is seen in?

Intermediate uveitis. ***Intermediate uveitis*** - **Snow banking** refers to the accumulation of inflammatory exudates on the surface of the **pars plana** and **ora serrata**, a characteristic sign of intermediate uveitis. - This condition primarily affects the **vitreous** and peripheral retina, often leading to symptoms like **floaters** and **decreased vision**. *White coat syndrome* - This refers to a phenomenon where a patient's **blood pressure is elevated** in a clinical setting due to anxiety, but is normal outside of the medical environment. - It has no ophthalmic manifestations or association with "snow banking." *Eales syndrome* - This is an idiopathic inflammatory condition primarily affecting the **peripheral retinal vasculature**, leading to **vasculitis**, occlusion, and neovascularization. - While it can cause vitreous hemorrhage, it does not typically present with "snow banking" as a primary feature. *Diabetic kidney disease* - This is a complication of **diabetes mellitus** characterized by damage to the small blood vessels in the kidneys, leading to impaired kidney function. - It is a systemic condition with no direct relationship to ocular "snow banking" or uveitis.

Q: What does extraretinal fibrovascular proliferation at the ridge indicate?

Stage III Retinopathy of Prematurity. ***Stage III Retinopathy of Prematurity*** - Extraretinal fibrovascular proliferation at the ridge is the defining characteristic of **Stage III Retinopathy of Prematurity (ROP)**. - This stage signifies significant **neovascularization** extending into the vitreous, increasing the risk of **retinal detachment**. *Normal retina* - A normal retina does not exhibit **fibrovascular proliferation** or a distinct ridge, as its vascularization is fully developed and confined to the retinal plane. - Absence of any abnormal vascular growth or demarcation line indicates a healthy, mature retinal structure. *Stage II Retinopathy of Prematurity* - Stage II ROP is characterized by a **ridge** that is elevated and appears three-dimensional, but it **lacks extraretinal fibrovascular proliferation**. - This stage represents progression from Stage I, where the demarcation line becomes a prominent ridge, but without new vessel formation outside the retina. *Stage I Retinopathy of Prematurity* - Stage I ROP is characterized by a thin, flat **demarcation line** distinguishing vascularized from avascular retina, without any significant elevation or fibrovascular proliferation. - This initial stage indicates an arrested phase of retinal vascular development, but without the more severe signs of neovascularization.

Q: Metamorphopsia is seen in?

Posterior uveitis. ***Posterior uveitis*** - **Metamorphopsia**, or the perception of distorted images, can occur in **posterior uveitis** due to inflammation affecting the **retina** or **choroid**, leading to retinal edema or detachment. - Inflammatory processes in the posterior segment can cause disruption of photoreceptor alignment and function, altering the perception of straight lines and object shapes. *Anterior uveitis* - Primarily affects the **iris** and **ciliary body**, causing symptoms like **pain**, **photophobia**, **redness**, and reduced vision due to cellular exudates in the anterior chamber. - While vision can be affected, **metamorphopsia** is not a typical hallmark of anterior uveitis, as the retinal architecture is generally preserved. *Cataract* - Involves **clouding of the eye's natural lens**, leading to blurred vision, glare, and dullness of colors. - It does not cause **metamorphopsia** because the retinal structure and its perception of shapes remain intact; the distortion is primarily visual clarity, not shape. *Glaucoma* - Characterized by **progressive optic nerve damage** and visual field loss, often associated with elevated intraocular pressure. - While it causes vision impairment, typically starting with **peripheral vision loss**, it does not cause **metamorphopsia**, as the retina itself is usually not distorted.

Q: What is the most common cause of anterior uveitis?

Idiopathic. ***Idiopathic*** - In a significant proportion of cases of **anterior uveitis**, a specific cause cannot be identified, leading to a diagnosis of idiopathic uveitis. - This highlights the multifactorial nature of the condition, where various triggers or underlying predispositions may not always be evident. *CMV* - **Cytomegalovirus (CMV)** typically causes a **posterior uveitis** or **retinitis**, especially in immunocompromised individuals. - While CMV can rarely cause anterior uveitis, it is not the most common cause. *Toxoplasma* - **Toxoplasmosis** is a frequent cause of **posterior uveitis** or **chorioretinitis**, characterized by focal necrotic lesions in the retina. - It is not a common cause of isolated anterior uveitis, although anterior chamber inflammation can occur secondary to posterior disease. *Ankylosing spondylitis* - **Ankylosing spondylitis** is a well-known systemic condition associated with **acute anterior uveitis**. - However, while a significant association exists, it is not the single most common cause when considering all cases of anterior uveitis, many of which remain idiopathic.

Q: Toxoplasma in children causes:

Chorioretinitis. ***Chorioretinitis*** - **Toxoplasmosis** is a significant cause of **chorioretinitis** in children, particularly congenital infections. - Ocular toxoplasmosis often presents with **retinal lesions** that can lead to vision loss. *Conjunctivitis* - **Conjunctivitis** is an inflammation of the conjunctiva, typically caused by bacterial or viral infections. - While it can occur in children, it is not a primary or characteristic manifestation of **Toxoplasma infection**. *Keratitis* - **Keratitis** is an inflammation of the cornea, often caused by bacterial, viral, or fungal infections, or sometimes trauma. - Although eyes are affected by **Toxoplasma**, **keratitis** is not the typical ophthalmic presentation; **chorioretinitis** is. *Papillitis* - **Papillitis** refers to inflammation of the optic disc (optic nerve head). - While **Toxoplasma** can rarely affect the optic nerve, **papillitis** is not the most common or specific ocular manifestation compared to **chorioretinitis**.

Question 1

Which of the following is not a cause of exudative retinal detachment?

Accepted Answer

High myopia

Answer

Scleritis

Answer

Toxemia of pregnancy

Answer

Central serous retinopathy

Question 2

Which of the following is NOT a characteristic of non-proliferative diabetic retinopathy?

Accepted Answer

Neovascularization

Answer

Hard exudates

Answer

Macular edema

Answer

Microaneurysm

Question 3

What condition is characterized by an "umbrella" configuration on fluorescein angiography?

Accepted Answer

Central serous retinopathy

Answer

Retinitis pigmentosa

Answer

Rhegmatogenous retinal detachment

Answer

Eale's disease

Question 4

The most common cause of vitreous hemorrhage in adults is

Accepted Answer

Diabetes

Answer

Retinal hole

Answer

Trauma

Answer

Hypertension

Question 5

The earliest change noticed in hypertensive retinopathy is:

Accepted Answer

Arteriolar spasm

Answer

Soft exudate

Answer

Venospasm

Answer

Hard exudate

Question 6

Snow banking is seen in?

Accepted Answer

Intermediate uveitis

Answer

White coat syndrome

Answer

Eales syndrome

Answer

Diabetic kidney disease

Question 7

What does extraretinal fibrovascular proliferation at the ridge indicate?

Accepted Answer

Stage III Retinopathy of Prematurity

Answer

Normal retina

Answer

Stage II Retinopathy of Prematurity

Answer

Stage I Retinopathy of Prematurity

Question 8

Metamorphopsia is seen in?

Accepted Answer

Posterior uveitis

Answer

Cataract

Answer

Glaucoma

Answer

Anterior uveitis

Question 9

What is the most common cause of anterior uveitis?

Accepted Answer

Idiopathic

Answer

CMV

Answer

Toxoplasma

Answer

Ankylosing spondylitis

Question 10

Toxoplasma in children causes:

Accepted Answer

Chorioretinitis

Answer

Keratitis

Answer

Papillitis

Answer

Conjunctivitis

Diseases of the Retina — MCQs

Diseases of the Retina — MCQs

On this page

Practice by Chapter

Want unlimited practice?