A 46-year-old man with poorly controlled hypertension undergoes fundoscopy. Findings include bilateral flame-shaped haemorrhages, multiple cotton wool spots, generalized arteriolar narrowing, arteriovenous nipping and copper wiring. Both optic discs are sharp with clearly defined margins. According to the Keith-Wagener-Barker classification, this retinopathy is:

• A Grade I
• B Grade II
• C Grade IV
• D Grade III ✓

Explanation

Grades I and II show only arteriolar changes such as narrowing and arteriovenous nipping without retinal lesions. Grade III adds retinal haemorrhages and exudates including cotton wool spots, exactly the picture described. The single finding that upgrades this to grade IV is papilloedema, and the sharp discs explicitly exclude it. Recognizing that grade IV is defined solely by the presence of disc oedema settles this item.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

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Written and medically reviewed by the StethoPrep medical team.