Diseases of the Retina — MCQs

Diseases of the Retina Indian Medical PG Practice Questions and MCQs

Question 631: All of the following cause panuveitis except?

A. Sarcoidosis
B. Sympathetic ophthalmitis
C. Ankylosing spondylitis (Correct Answer)
D. Toxoplasmosis

Explanation: ***Ankylosing spondylitis*** - This condition primarily causes **acute anterior uveitis**, affecting the front part of the eye, not typically the entire uveal tract (**panuveitis**). - Its association with uveitis is usually **unilateral** and presents with symptoms like pain, redness, and photophobia. *Sarcoidosis* - **Sarcoidosis** is a systemic inflammatory disease that can lead to **granulomatous panuveitis**, affecting the anterior, intermediate, and posterior segments of the eye. - Ocular involvement in sarcoidosis can manifest as choroiditis, retinitis, and vitritis, indicative of widespread inflammation. *Sympathetic ophthalmitis* - This is a rare, bilateral, **granulomatous panuveitis** that occurs after a penetrating ocular injury or surgery to one eye. - It involves inflammation of the entire uveal tract in both the injured and the fellow, uninjured eye. *Toxoplasmosis* - **Toxoplasmosis** often causes a focal **retinochoroiditis** which can spread to involve the vitreous and anterior chamber, leading to a form of **panuveitis**. - The inflammatory response is primarily to the parasitic infection, manifesting as a necrotizing retinitis with significant surrounding inflammation.

Question 632: Which of the following conditions is associated with granulomatous uveitis?

A. Fuchs' heterochromic iridocyclitis
B. Behcet's disease
C. Vogt-Koyanagi-Harada's disease (Correct Answer)
D. Psoriatic arthritis

Explanation: ***Vogt-Koyanagi-Harada's disease*** - This systemic autoimmune condition characteristically presents with **bilateral, chronic granulomatous panuveitis**. - Other typical findings include **neurologic symptoms** (meningism, tinnitus) and **dermatologic manifestations** (vitiligo, poliosis, alopecia). *Fuchs' heterochromic iridocyclitis* - This condition is typically associated with **non-granulomatous anterior uveitis**. - Key features include **heterochromia** (different colored irises), diffuse stellate keratic precipitates, and often a cataract. *Behcet's disease* - Behcet's disease causes a **non-granulomatous panuveitis**, which is often recurrent and severe. - It is characterized by **recurrent oral and genital ulcers**, erythema nodosum, and pathergy. *Psoriatic arthritis* - Uveitis associated with psoriatic arthritis is usually **acute, unilateral, and non-granulomatous anterior uveitis**. - It is often seen in conjunction with **psoriatic skin lesions** and arthritis, commonly affecting the peripheral joints.

Question 633: Which of the following conditions does not lead to neovascularization of the iris?

A. CRVO
B. Diabetic retinopathy
C. Fuch's heterochromic cyclitis
D. Congenital cataract (Correct Answer)

Explanation: ***Congenital cataract*** - **Congenital cataract** is a clouding of the lens present at birth and typically does not lead to **retinal ischemia** or subsequent **neovascularization** of the iris. - The primary issue is obstruction of light transmission rather than a vascular derangement prompting new vessel formation. - This is the correct answer as it does NOT cause iris neovascularization. *CRVO* - **Central Retinal Vein Occlusion (CRVO)** leads to significant **retinal ischemia**, which triggers the release of **pro-angiogenic factors** like VEGF. - These factors cause **neovascularization of the iris** (rubeosis iridis) and angle, leading to **neovascular glaucoma**. *Diabetic retinopathy* - **Proliferative diabetic retinopathy** is a leading cause of **iris neovascularization** due to widespread retinal **ischemia** and subsequent release of **VEGF**. - The new vessels grow on the iris surface and into the angle, causing **neovascular glaucoma**. *Fuchs heterochromic iridocyclitis* - **Fuchs heterochromic iridocyclitis** is a chronic, low-grade **anterior uveitis** characterized by iris heterochromia and fine keratic precipitates. - The fine vessels visible on the iris are **normal iris vessels made prominent** due to **iris stromal atrophy**, NOT true pathological neovascularization (rubeosis iridis). - Unlike CRVO and diabetic retinopathy, Fuchs does **NOT** cause true iris neovascularization driven by retinal ischemia and VEGF.

Question 634: Mizuo's phenomenon is seen in:

A. Oguchi's disease (Correct Answer)
B. Fundus albipunctatus
C. Fundus flavimaculatus
D. Choroideremia

Explanation: ***Oguchi's disease*** - **Mizuo's phenomenon** is a characteristic feature of **Oguchi's disease**, an **autosomal recessive** form of congenital stationary night blindness. - It involves the unusual finding of a **golden-yellowish or grayish discoloration of the fundus** in the light-adapted state, which disappears after prolonged dark adaptation. *Fundus albipunctatus* - This condition is characterized by **numerous small, discrete white or yellow-white flecks** scattered diffusely across the fundus. - While it is also a form of congenital stationary night blindness, it does not exhibit the **Mizuo's phenomenon**. *Fundus flavimaculatus* - This term is often used interchangeably with **Stargardt's disease**, which is a **macular dystrophy** characterized by progressive vision loss and yellow flecks around the macula. - This condition does not involve **Mizuo's phenomenon** or night blindness of the static type. *Choroideremia* - This is an **X-linked recessive** progressive chorioretinal degeneration primarily affecting males, leading to severe vision loss and night blindness due to loss of the **choroid**, **retinal pigment epithelium**, and **photoreceptors**. - It is a degenerative condition and does not present with the reversible fundus discoloration seen in **Mizuo's phenomenon**.

Question 635: A cherry red spot is found in which of the following conditions?

A. GM1 gangliosidosis
B. Tay-Sach's disease (Correct Answer)
C. Retinopathy of prematurity
D. Gaucher's disease

Explanation: ***Tay-Sach's disease*** - The **cherry-red spot** in Tay-Sachs disease is due to the accumulation of **GM2 gangliosides** in the retinal ganglion cells, making the fovea appear red due to the normal choroidal vasculature. - This is a classic finding in **infantile Tay-Sachs disease**, a lysosomal storage disorder caused by a deficiency of the **hexosaminidase A enzyme**. *Gangliosidosis* - While GM1 gangliosidosis can rarely present with a cherry-red spot, it is more commonly associated with **coarse facial features**, hepatosplenomegaly, and skeletal abnormalities. - The **enzyme deficiency** in GM1 gangliosidosis is **beta-galactosidase**, differing from Tay-Sachs disease. *Retinopathy of prematurity* - This condition involves **abnormal blood vessel growth in the retina** of premature infants, often leading to retinal detachment and vision loss. - It does not typically present with a **cherry-red spot**; rather, it is characterized by areas of vascularized and avascular retina. *Gaucher's disease* - Gaucher's disease is characterized by the accumulation of **glucocerebroside** in macrophages, leading to hepatosplenomegaly, bone pain, and neurological symptoms in some types. - A **cherry-red spot** is not a typical ocular finding in Gaucher's disease; **strabismus** and **oculomotor apraxia** are more common.

Question 636: Fluorescein dye for ophthalmological diagnosis is injected into:

A. Antecubital vein (Correct Answer)
B. Popliteal vein
C. Femoral vein
D. Subclavian vein

Explanation: ***Antecubital vein*** - Fluorescein angiography requires rapid delivery of the dye into the **systemic circulation** for quick visualization of retinal and choroidal vasculature. - The **antecubital vein** is a readily accessible, large superficial vein that allows for quick and efficient intravenous dye injection. *Popliteal vein* - The popliteal vein is located behind the **knee** and is not a standard or practical site for routine intravenous injections, especially when rapid delivery to the eye is needed. - Its location makes it less accessible and potentially more uncomfortable for the patient compared to an arm vein. *Femoral vein* - The femoral vein is a large, deep vein in the **groin**, typically reserved for central venous access or specific procedures due to the increased risk of complications like infection or hematoma. - It is not routinely used for peripheral intravenous injections such as fluorescein, where a more superficial and accessible vein is preferred. *Subclavian vein* - The subclavian vein is a **central vein** located under the clavicle, accessed via a more invasive procedure, usually for central venous catheters or hemodialysis access. - It carries higher risks compared to peripheral venipuncture and is not chosen for simple diagnostic dye injections like fluorescein.

Question 637: What is the best diagnostic test for Best's disease?

A. Dark adaptation
B. ERG
C. EOG (Correct Answer)
D. Gonioscopy

Explanation: ***EOG*** - The **electro-oculogram (EOG)** measures the potential difference between the cornea and Bruch's membrane, which is severely abnormal in **Best's disease**. - A characteristic feature is a **reduced Arden ratio (Light Peak/Dark Trough)**, typically below 1.5, even in asymptomatic carriers. *Dark adaptation* - This test assesses the eye's ability to adapt to low light conditions, primarily indicative of **rod photoreceptor function**. - While visual disturbances can occur in Best's disease, dark adaptation is not the primary diagnostic test and might be normal or mildly affected. *ERG* - The **electroretinogram (ERG)** measures the electrical responses of the **photoreceptors and inner retinal cells** to light stimuli. - In Best's disease, the ERG is typically **normal**, as the primary pathology affects the RPE and not directly the photoreceptors (initially). *Gonioscopy* - **Gonioscopy** is an examination technique used to visualize the **anterior chamber angle** of the eye, mainly for diagnosing and managing **glaucoma**. - It is unrelated to Best's disease, which is a **macular dystrophy** affecting the retina and RPE.

Question 638: Which of the following conditions is NOT associated with retinitis pigmentosa?

A. Kearns-Sayre Syndrome
B. Usher Syndrome
C. Marfan's Syndrome (Correct Answer)
D. Bassen-Kornzweig Syndrome

Explanation: ***Marfan's Syndrome*** - Marfan's Syndrome is primarily a **connective tissue disorder** affecting the **cardiovascular system**, **skeletal system**, and **eyes** (e.g., lens dislocation). - It is **not directly associated** with the progressive **photoreceptor degeneration** characteristic of retinitis pigmentosa. *Usher Syndrome* - Usher Syndrome is a **recessive genetic disorder** characterized by **hearing loss** and progressive **vision loss** due to retinitis pigmentosa. - It involves both **auditory** and **visual impairments**, directly linking it to retinitis pigmentosa. *Kearns-Sayre Syndrome* - Kearns-Sayre Syndrome is a **mitochondrial disorder** that includes **external ophthalmoplegia**, **cardiac conduction defects**, and often **pigmentary retinopathy** resembling retinitis pigmentosa. - The retinal degeneration in Kearns-Sayre syndrome is a **hallmark ocular manifestation**. *Bassen-Kornzweig Syndrome* - Also known as **abetalipoproteinemia**, this is a rare **autosomal recessive disorder** characterized by the inability to absorb **dietary fats and fat-soluble vitamins** (especially vitamin A). - Severe **vitamin A deficiency** can lead to atypical retinitis pigmentosa-like retinal degeneration and **night blindness**.

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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