Diseases of the Retina — MCQs
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What is the most common complication of pars planitis?
Metamorphopsia is seen in?
Shaffer's sign is seen in ?
What condition is characterized by cherry red spot at the macula with retinal whitening?
Foster's Fuchs spots are specifically associated with which condition?
What is Eales disease?
Which ophthalmological investigation is most appropriate for detailed visualization of the fundus at close range?
Hemorrhage in the vitreous humour is caused by all of the following except:
Large, white keratic precipitates (mutton-fat KPs) are characteristically seen in?
The best investigation for diagnosing Best disease is
Diseases of the Retina Indian Medical PG Practice Questions and MCQs
Question 581: What is the most common complication of pars planitis?
- A. Cataract (clouding of the lens) (Correct Answer)
- B. Retinal detachment (separation of retina)
- C. Cystoid macular edema (swelling of central retina)
- D. Glaucoma (increased intraocular pressure)
Explanation: **Cataract (clouding of the lens)** - **Cataract formation** is the most common ocular complication in patients with pars planitis, often due to chronic inflammation or steroid use. - The inflammation can disrupt lens metabolism, leading to **opacification** over time. *Retinal detachment (separation of retina)* - While possible, **retinal detachment** is a less common complication of pars planitis compared to cataract formation. - It can occur in severe cases, often due to vitreous traction on fragile peripheral retina or tears associated with **snowbanking**. *Cystoid macular edema (swelling of central retina)* - **Cystoid macular edema (CME)** is a significant cause of vision loss in pars planitis but is not the most frequent complication overall. - It results from the inflammatory compromise of the blood-retinal barrier, leading to fluid accumulation in the **macula**. *Glaucoma (increased intraocular pressure)* - **Glaucoma** can occur in pars planitis, often secondary to chronic inflammation affecting the **trabecular meshwork** or prolonged steroid use. - However, it is less common than cataracts and CME as a primary complication.
Question 582: Metamorphopsia is seen in?
- A. Cataract
- B. Glaucoma
- C. Anterior uveitis
- D. Posterior uveitis (Correct Answer)
Explanation: ***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.
Question 583: Shaffer's sign is seen in ?
- A. Acute angle-closure glaucoma
- B. Diabetic retinopathy
- C. Age-related macular degeneration
- D. Retinal detachment (Correct Answer)
Explanation: ***Retinal detachment*** - **Shaffer's sign** refers to the presence of **pigment cells** (tobacco dust) in the **anterior vitreous**, indicating a retinal break or detachment. - This sign is due to the release of retinal pigment epithelium cells into the vitreous following a tear in the retina. *Acute angle-closure glaucoma* - This condition is characterized by a **sudden increase in intraocular pressure** due to blocked fluid outflow, causing pain, redness, and blurred vision. - It does not involve pigment cells in the vitreous, but rather changes in the **anterior chamber angle**. *Diabetic retinopathy* - This is a microvascular complication of diabetes, leading to damage to the blood vessels in the retina, causing **hemorrhages**, **exudates**, and **neovascularization**. - It does not typically present with free pigment in the vitreous as a primary diagnostic sign. *Age-related macular degeneration* - This condition affects the **macula**, often causing distorted vision and central vision loss, and is characterized by drusen and atrophy. - While it can involve retinal changes, it does not classically present with pigment cells in the vitreous as a diagnostic indicator.
Question 584: What condition is characterized by cherry red spot at the macula with retinal whitening?
- A. CRVO
- B. CRAO (Correct Answer)
- C. Diabetic retinopathy
- D. Syphilitic retinopathy
Explanation: ***CRAO*** - **Central retinal artery occlusion (CRAO)** is characterized by **sudden, profound, painless monocular vision loss**. - The classic funduscopic finding is a **cherry-red spot at the macula** with diffuse **retinal whitening** due to ischemia. *CRVO* - **Central retinal vein occlusion (CRVO)** presents with **painless vision loss** but typically shows **hemorrhages**, **dilated tortuous veins**, and **cotton wool spots** on funduscopic exam. - It does not usually cause retinal whitening or a cherry-red spot. *Diabetic retinopathy* - **Diabetic retinopathy** is characterized by **microaneurysms**, **hemorrhages**, **hard exudates**, and **cotton wool spots**, and can lead to neovascularization. - It does not present with acute retinal whitening or a cherry-red spot in the macula. *Syphilitic retinopathy* - **Syphilitic retinopathy** can cause a variety of presentations, including **retinal vasculitis**, **chorioretinitis**, and **optic neuritis**. - It does not typically manifest as a cherry-red spot with diffuse retinal whitening at the macula.
Question 585: Foster's Fuchs spots are specifically associated with which condition?
- A. Myopia (Correct Answer)
- B. Astigmatism
- C. Hypermetropia
- D. Presbyopia
Explanation: ***Myopia*** - **Foster's-Fuchs spots** are a pathognomonic finding in **pathologic myopia**, characterized by subretinal neovascularization and hemorrhage at the macula. - This condition is associated with high degrees of **myopia** (nearsightedness), leading to thinning and stretching of the retina and choroid. - The spots represent **pigmented scars** from resolved choroidal neovascular membrane hemorrhages. *Hypermetropia* - **Hypermetropia** (farsightedness) does not typically lead to Foster's-Fuchs spots; these spots are specific to the degenerative changes seen in high myopia. - Ocular complications in hypermetropia are different and may include **angle-closure glaucoma** or **accommodative esotropia**. *Astigmatism* - **Astigmatism** is an optical defect where the eye fails to focus light equally on the entire retina, causing blurred vision at any distance. - It is not associated with the development of **Foster's-Fuchs spots**, which are a specific macular degeneration seen in myopia. *Presbyopia* - **Presbyopia** is the age-related loss of accommodation due to decreased lens elasticity. - It is a physiological change and is not associated with **Foster's-Fuchs spots** or the structural changes seen in pathologic myopia.
Question 586: What is Eales disease?
- A. Recurrent optic neuritis
- B. Recurrent periphlebitis retinae (Correct Answer)
- C. Recurrent papilloedema
- D. None of the options
Explanation: **Recurrent periphlebitis retinae** - **Eales disease** is an idiopathic inflammatory condition characterized by **recurrent periphlebitis retinae**, particularly affecting the peripheral retinal veins. - It can lead to **retinal ischemia**, neovascularization, vitreous hemorrhage, and retinal detachment. *Recurrent optic neuritis* - **Optic neuritis** is inflammation of the optic nerve, typically causing acute vision loss and pain with eye movement. - It is a common manifestation of **multiple sclerosis** but is not the primary definition of Eales disease. *Recurrent papilloedema* - **Papilledema** is swelling of the optic disc due to increased intracranial pressure. - While it can cause visual disturbances, it is a distinct condition and not the defining characteristic of Eales disease. *None of the options* - This option is incorrect because "Recurrent periphlebitis retinae" accurately describes Eales disease.
Question 587: Which ophthalmological investigation is most appropriate for detailed visualization of the fundus at close range?
- A. Retinoscopy
- B. Indirect ophthalmoscopy
- C. Direct ophthalmoscopy (Correct Answer)
- D. Oblique illumination test
Explanation: ***Direct ophthalmoscopy*** - This technique allows for a **highly magnified**, upright image of the fundus, making it ideal for **detailed visualization** of the macula and optic disc at close range. - It provides a **small field of view** but excellent resolution for observing subtle changes. *Retinoscopy* - Retinoscopy is primarily used to objectively determine the **refractive error** of the eye, not for detailed fundus visualization. - It assesses how light is reflected from the retina to determine the need for corrective lenses. *Indirect ophthalmoscopy* - While it provides a **wider field of view** and a stereoscopic image, it offers **less magnification** and thus less detail compared to direct ophthalmoscopy. - It is often used for evaluating the peripheral retina and in cases where direct ophthalmoscopy is difficult. *Oblique illumination test* - This test is used to examine the **anterior segment of the eye**, such as the cornea, anterior chamber, and lens. - It involves shining a light at an angle and observing structures, not for visualizing the fundus.
Question 588: Hemorrhage in the vitreous humour is caused by all of the following except:
- A. Diabetes mellitus
- B. CRVO
- C. Glaucoma (Correct Answer)
- D. Trauma
Explanation: ***Glaucoma*** - **Glaucoma** is primarily characterized by optic nerve damage due to elevated intraocular pressure, leading to **visual field loss**. - While it can lead to vision impairment, it does not typically cause **vitreous hemorrhage** directly, as it doesn't involve the proliferation of fragile blood vessels. *Diabetes mellitus* - **Diabetic retinopathy** is a leading cause of vitreous hemorrhage, especially in its proliferative form, due to the growth of **fragile new blood vessels** (neovascularization) that can bleed into the vitreous. - These new vessels are prone to rupture, leading to sudden vision loss from vitreous bleeding. *CRVO* - **Central Retinal Vein Occlusion (CRVO)** often leads to **retinal ischemia** and the release of **angiogenic factors** (e.g., VEGF), which can cause **neovascularization** on the retina or iris. - These newly formed, fragile vessels can rupture and bleed into the vitreous cavity. *Trauma* - **Ocular trauma**, such as a direct blow to the eye or a penetrating injury, can directly rupture retinal or choroidal blood vessels, leading to a **vitreous hemorrhage**. - This can range from mild bleeding to extensive hemorrhage, depending on the severity and nature of the injury.
Question 589: Large, white keratic precipitates (mutton-fat KPs) are characteristically seen in?
- A. Hemorrhagic uveitis
- B. Old healed uveitis
- C. Granulomatous uveitis (Correct Answer)
- D. Acute anterior uveitis
Explanation: ***Granulomatous uveitis*** - **Mutton-fat keratic precipitates (KPs)** are large, greasy-appearing white deposits on the corneal endothelium, characteristic of **granulomatous inflammation**. - These KPs are composed of macrophages and epithelioid cells, reflecting a **chronic, cell-mediated immune response** seen in granulomatous conditions. *Hemorrhagic uveitis* - This condition involves significant **intraocular bleeding**, which would manifest as hyphema or vitreous hemorrhage, not mutton-fat KPs. - While inflammation may be present, the defining feature is blood, which obscures vision differently than KPs. *Old healed uveitis* - After uveitis heals, KP morphology can change, often appearing smaller, more pigmented, or forming distinct patterns such as **Arlt's triangle**, but not typically actively large, white mutton-fat KPs. - Healed KPs often reflect a less active or resolved inflammatory process, unlike fresh mutton-fat KPs. *Acute anterior uveitis* - This typically presents with smaller, finer, and more numerous **non-granulomatous KPs** (sometimes called "stellate KPs"), in contrast to the large, greasy mutton-fat KPs. - The inflammation is usually acute and less focally organized compared to granulomatous forms.
Question 590: The best investigation for diagnosing Best disease is
- A. Electrooculogram (EOG) (Correct Answer)
- B. Nerve conduction study (Electroneurogram)
- C. Electroretinogram (ERG)
- D. Electroencephalogram (EEG)
Explanation: ***Electrooculogram (EOG)*** - **Best disease** (Best vitelliform macular dystrophy) is a genetic disorder affecting the retinal pigment epithelium (RPE), leading to abnormal **light-induced changes in EOG potentials**. - A **significantly reduced or absent Arden ratio** (ratio of light peak to dark trough) on the **electrooculogram (EOG)** is pathognomonic for Best disease, even in early stages when vision may be unaffected. *Nerve conduction study (Electroneurogram)* - A **nerve conduction study** measures the speed and strength of electrical signals as they travel through peripheral nerves. - This test is used for diagnosing conditions affecting **peripheral nerves**, such as neuropathies, and has no relevance to retinal disorders. *Electroretinogram (ERG)* - An **electroretinogram (ERG)** measures the electrical responses of the **photoreceptors and inner retinal cells** to light stimulation. - While ERG is useful in diagnosing various retinal disorders, it usually shows a **normal or nearly normal result in Best disease**, as the primary defect is in the RPE and not the photoreceptors themselves early in the disease course. *Electroencephalogram (EEG)* - An **electroencephalogram (EEG)** records the electrical activity of the **brain**. - It is primarily used to diagnose conditions like **epilepsy, sleep disorders**, and other neurological conditions affecting brain function, and has no utility in diagnosing retinal diseases.
Practice by Chapter
Retinal Anatomy and Physiology
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Age-Related Macular Degeneration
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Diabetic Retinopathy
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Retinal Vascular Diseases
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Retinal Detachment
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Hereditary Retinal Dystrophies
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Inflammatory Retinal Diseases
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Retinal Tumors
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Retinopathy of Prematurity
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Retinal Imaging Techniques
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Intravitreal Pharmacotherapy
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Vitreoretinal Surgery
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