Retina (Vascular Disorders, Detachment, Macular Disorders, Retinoblastoma) MCQs

Ophthalmology · 63 free questions with answers & explanations.

1. A 2-year-old child is brought with leukocoria (white pupillary reflex) in the right eye. Examination under anaesthesia reveals a white intraocular mass with calcification. The most likely diagnosis and the gene involved are:
2. A 65-year-old hypertensive diabetic presents with sudden painless loss of vision in the right eye. Fundus shows dilated tortuous veins, dot and blot hemorrhages in all four quadrants, disc edema, and cotton wool spots. The most likely diagnosis is:
3. A 55-year-old myopic patient develops sudden flashing lights followed by a shower of floaters and a curtain-like shadow from below in one eye. On fundus examination the retina is elevated with an underlying subretinal fluid and a horseshoe tear at the supero-temporal periphery. What is the pathophysiology of this detachment?
4. On OCT examination, a 70-year-old patient with wet age-related macular degeneration shows subretinal fluid and a choroidal neovascular membrane. Which anti-VEGF drug was the first approved specifically for neovascular AMD?
5. A 30-year-old woman with type 1 diabetes for 18 years presents with vitreous hemorrhage. Fundus fluorescein angiography shows new vessels at the disc (NVD) with fibrovascular proliferation. Which laser treatment modality is indicated for this stage?
6. An 18-month-old child with unilateral retinoblastoma undergoes enucleation. Histopathology shows invasion of the optic nerve up to but not reaching the surgical cut end and no choroidal invasion. According to the International Classification for Intraocular Retinoblastoma, this is classified as:
7. A 40-year-old man presents with a branch retinal artery occlusion (BRAO) in the inferior temporal territory. On OCT, the involved area shows marked inner retinal thickening acutely. What is the characteristic appearance on fluorescein angiography (FFA) in the first 24 hours?
8. A premature infant born at 26 weeks gestation is screened for retinopathy of prematurity (ROP). Zone II posterior disease with plus disease and more than 5 contiguous or 8 total clock hours of stage 3 ROP is classified as:
9. A 60-year-old woman presents with metamorphopsia and a central scotoma. OCT shows subretinal fluid, pigment epithelial detachment, and a type 2 choroidal neovascular membrane. The current first-line recommended anti-VEGF agent for neovascular AMD based on the VIEW 1 and VIEW 2 trial evidence is:
10. A 35-year-old hyperopic woman presents with Amsler grid distortion and a small serous pigment epithelial detachment at the fovea on OCT. EDI-OCT shows pachychoroid and dilated Haller layer vessels. Indocyanine green angiography confirms choroidal hyperpermeability. The most likely diagnosis is:
11. A 65-year-old diabetic with proliferative diabetic retinopathy (PDR) develops a sudden, dense vitreous hemorrhage obscuring the fundus. B-scan ultrasonography shows no retinal detachment. According to current evidence-based guidelines (DRS/ETDRS), the MOST appropriate next step is:
12. A 45-year-old woman presents with a sudden scotoma in her left eye. Fundoscopy reveals a whitish-grey area at the posterior pole with a cherry-red spot. There is no afferent pupillary defect. The most likely pathology and the preferred time window for intervention with ocular massage/anterior chamber paracentesis is:
13. In the classification of rhegmatogenous retinal detachment (RRD), which feature defines 'PVR grade C' (proliferative vitreoretinopathy) according to the updated Silicone Oil Study classification?
14. A 2-year-old child is brought with leukocoria. Retinoblastoma is confirmed. Ultrasound shows calcification; MRI shows no optic nerve enhancement. International Classification of Retinoblastoma (ICRB) Group D is diagnosed in the right eye (the only eye with disease). According to current management protocols, the preferred treatment is:
15. In the CATT (Comparison of Age-related Macular Degeneration Treatment Trials), the primary finding regarding ranibizumab versus bevacizumab for neovascular AMD after 2 years was:
16. The CATT (Comparison of Age-Related Macular Degeneration Treatments Trials) compared ranibizumab vs. bevacizumab for wet AMD. Which conclusion best summarizes the 2-year CATT findings?
17. A 35-year-old myope presents with sudden onset of flashes and floaters followed by a dark curtain from below. OCT shows subretinal fluid with retinal pigment epithelium displacement. B-scan shows bullous inferior retinal detachment without visible breaks on indirect ophthalmoscopy. The most appropriate next diagnostic step is:
18. In the Knudson 'two-hit hypothesis' for retinoblastoma, which statement correctly differentiates sporadic from hereditary forms in terms of molecular events?
19. Central serous chorioretinopathy (CSCR) in its chronic form is associated with which OCT finding that best differentiates it from neovascular AMD on multimodal imaging?
20. International Classification of Retinoblastoma (IIRC) Group E tumors are characterized by which features that mandate enucleation as the primary treatment?
21. The CATT (Comparison of Age-related macular degeneration Treatments Trials) demonstrated equivalence between ranibizumab and bevacizumab for neovascular AMD. The key finding regarding dosing regimens was:
22. In rhegmatogenous retinal detachment, subretinal fluid accumulation occurs due to which primary physiological mechanism?
23. A child with retinoblastoma undergoes Reese-Ellsworth classification. Under the International Classification of Retinoblastoma (ICRB/ABC classification), Group E tumors are defined by which criterion that makes them distinct from Group D?
24. The CRUISE trial evaluated ranibizumab for macular edema secondary to central retinal vein occlusion. The primary outcome showed that the drug achieved its endpoint. Which anti-VEGF agent was subsequently approved by FDA for CRVO-related macular edema based on the GALILEO/COPERNICUS trials?
25. In Stargardt disease (ABCA4 mutations), the characteristic 'silent choroid' on fluorescein angiography occurs because:
26. In the MARINA and ANCHOR trials, which anti-VEGF agent demonstrated benefit for neovascular age-related macular degeneration (AMD), and what was the primary endpoint used?
27. Geographic atrophy in dry AMD develops primarily due to:
28. In rhegmatogenous retinal detachment, lattice degeneration is associated with which type of retinal break?
29. Knudson's 'two-hit hypothesis' in retinoblastoma predicts that hereditary cases will:
30. The Reese-Ellsworth classification for retinoblastoma has largely been replaced by the International Classification of Retinoblastoma (ICRB/IIRC). In the ICRB, Group E eyes are characterized by:
31. In the CATT (Comparison of AMD Treatments Trials), which finding regarding ranibizumab versus bevacizumab for neovascular AMD was most clinically significant?
32. The Watzke-Allen test and the photostress recovery time are specifically used to evaluate dysfunction at which retinal level?
33. A 35-year-old male presents with sudden-onset inferior visual field loss. Fundus exam shows a superotemporal horseshoe tear with surrounding subretinal fluid not extending to the macula. The MOST appropriate management is:
34. In retinoblastoma, the International Classification (IIRC) Group E eye is defined by the presence of:
35. The MARINA trial established intravitreal ranibizumab as effective for which specific subtype of choroidal neovascularisation (CNV) in AMD?
36. The CATT (Comparison of Age-related Macular Degeneration Treatments Trials) study compared ranibizumab versus bevacizumab for neovascular AMD. Which finding was clinically most significant at 2 years?
37. In proliferative diabetic retinopathy, the Early Treatment Diabetic Retinopathy Study (ETDRS) defined clinically significant macular edema (CSME) based on which criterion?
38. A 45-year-old highly myopic patient develops sudden floaters and a peripheral horseshoe retinal tear without subretinal fluid on slit-lamp biomicroscopy. The appropriate management is:
39. Sorafenib and sunitinib (oral anti-VEGF tyrosine kinase inhibitors) were found to be associated with which ocular complication as a class effect?
40. In retinoblastoma, the International Classification System (IIRC) Group D eyes are characterized by:
41. The CATT (Comparison of Age-Related Macular Degeneration Treatments Trials) established non-inferiority of bevacizumab compared to ranibizumab for neovascular AMD. The key molecular difference between these agents is:
42. In the Wills Eye classification of rhegmatogenous retinal detachment (RRD), which of the following findings most strongly indicates the need for scleral buckling rather than primary vitrectomy?
43. The RB1 gene product (pRb) normally restrains the cell cycle by binding to which transcription factor, preventing S-phase entry?
44. In central retinal artery occlusion (CRAO), the 'cherry red spot' at the macula occurs because:
45. The international classification of retinoblastoma (IIRC/LIRB classification) — Group E disease includes eyes with:
46. In central retinal artery occlusion (CRAO), the characteristic fundus finding that helps distinguish it from other causes of sudden painless visual loss is:
47. Macular hole formation (full-thickness) is best explained by which pathomechanism according to current understanding?
48. Age-related macular degeneration (AMD) — wet (neovascular) type — is characterized by choroidal neovascularization (CNV). The MOST accurate imaging modality to precisely classify CNV as type 1 (sub-RPE), type 2 (sub-retinal), or type 3 (retinal angiomatous proliferation — RAP) is:
49. A 65-year-old hypertensive patient develops sudden painless loss of vision in the right eye. FFA shows delayed arteriovenous transit time, retinal hemorrhages in all quadrants in a 'flame and dot' pattern (blood and thunder fundus), disc edema, and dilated tortuous veins. The diagnosis is central retinal vein occlusion (CRVO). Which finding on examination would indicate ischemic CRVO (high risk for neovascular complications) rather than non-ischemic CRVO?
50. In age-related macular degeneration (AMD), the PRIMARY risk factor for conversion from dry (atrophic) AMD to wet (neovascular) AMD is:
51. Rhegmatogenous retinal detachment (RRD) is most commonly associated with which predisposing ocular condition?
52. Retinoblastoma with extraocular extension to the optic nerve beyond the surgical cut end is classified as which pTNM pathological T stage?
53. A 68-year-old hypertensive man presents with sudden painless loss of vision. Fundus shows disc edema, dilated tortuous veins in all quadrants, flame hemorrhages, and a cherry red spot at the fovea. The diagnosis is central retinal artery occlusion (CRAO). Which treatment has shown efficacy within the therapeutic window of 4.5 hours?
54. Age-related macular degeneration (AMD) — geographic atrophy (GA) is characterized on fundus autofluorescence (FAF) as:
55. A 55-year-old male presents with metamorphopsia and decreased central vision. OCT shows a hyporeflective space between the neurosensory retina and RPE with an overlying point of traction from the posterior vitreous cortex at the fovea. Visual acuity is 6/18. The MOST appropriate management at this stage is:
56. A 60-year-old hypertensive man presents with sudden painless loss of vision in the left eye. Fundus examination reveals diffuse flame-shaped haemorrhages in all four quadrants, disc oedema, dilated tortuous veins, and cotton-wool spots. OCT shows macular oedema. What is the primary treatment goal for the macular oedema in this condition?
57. A 2-year-old child is brought with leukocoria. Fundus under EUA shows a white mass with calcification. Retinoblastoma is suspected. Genetic testing reveals a germline RB1 mutation. The tumour in the right eye is confined to the retina with no optic nerve or choroidal invasion, classified as group C (IIRC classification). The contralateral eye is normal. What is the most appropriate management?
58. A 35-year-old myope presents with a 2-day history of floaters and a curtain across his inferior visual field. B-scan ultrasonography confirms a bullous superior rhegmatogenous retinal detachment with a U-shaped tear at 11 o'clock. Best corrected visual acuity is 6/6. What finding on examination would indicate that immediate surgery (within 24 hours) is essential rather than semi-urgent?
59. OCT of the macula in a 72-year-old woman with dry AMD shows intraretinal fluid, subretinal fluid, and a sub-retinal pigment epithelium (sub-RPE) lesion with double-layer sign. Fluorescein angiography demonstrates early hyperfluorescence with late leakage in the subfoveal region. The lesion is best classified as:
60. In the ETDRS (Early Treatment Diabetic Retinopathy Study), the definition of 'clinically significant macular edema' (CSME) includes which of the following criteria?
61. In proliferative vitreoretinopathy (PVR), the cellular component primarily responsible for tractional membrane formation on the inner retinal surface (epiretinal membrane) is:
62. In the DRS (Diabetic Retinopathy Study), the 'high-risk characteristics' (HRC) for severe visual loss that mandated immediate panretinal photocoagulation (PRP) included which combination?
63. In age-related macular degeneration (AMD), the AREDS formulation reduces progression to advanced AMD in patients with Category 3 or 4 disease. The antioxidant combination used in AREDS2 (replacing beta-carotene due to lung cancer risk in smokers) is: