A 58-year-old man admitted with severe headache has blood pressure recorded as 230/140 mmHg. Fundus examination shows bilateral flame-shaped hemorrhages, cotton wool spots, arteriolar narrowing, and bilateral optic disc swelling. What is the Keith-Wagener-Barker grade of hypertensive retinopathy?
- A Grade 1
- B Grade 4 ✓
- C Grade 3
- D Grade 2
Correct answer: B. Grade 4
Explanation
The Keith-Wagener-Barker classification grades hypertensive retinopathy from 1 to 4. Grade 4 is defined by the presence of papilledema along with the features of grade 3, which are hemorrhages and cotton wool spots (soft exudates). Grade 3 differs from grade 4 only by the absence of disc swelling. Grades 1 and 2 show only generalized and focal arteriolar narrowing respectively. The presence of bilateral disc edema in this severely hypertensive patient places him squarely in grade 4.
Reference: Khurana Comprehensive Ophthalmology, 7th ed.
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Written and medically reviewed by the StethoPrep medical team.