ABO Ocular Disease & Pathology 3 — Questions and Answers
Question 1: A 70-year-old diabetic patient presents with new vessels at the disc (NVD) and vitreous hemorrhage. According to ETDRS criteria, this represents which stage of diabetic retinopathy?
- Moderate non-proliferative DR
- Severe non-proliferative DR
- Proliferative DR without high-risk characteristics
- High-risk proliferative DR (Correct answer)
Correct answer: High-risk proliferative DR
NVD of any size with vitreous hemorrhage meets ETDRS high-risk proliferative DR criteria, requiring prompt pan-retinal photocoagulation.
Question 2: Which nerve fiber bundle is most susceptible to early damage in primary open-angle glaucoma, producing an arcuate scotoma on visual field testing?
- Papillomacular bundle
- Temporal raphe fibers
- Superior and inferior arcuate fibers (Correct answer)
- Nasal step fibers
Correct answer: Superior and inferior arcuate fibers
The superior and inferior arcuate bundles are most vulnerable to glaucomatous damage, producing arcuate (Bjerrum) scotomas.
Question 3: A child presents with a unilateral white pupillary reflex (leukocoria). Which of the following is the most urgent diagnosis to rule out?
- Coats disease
- Persistent fetal vasculature
- Retinoblastoma (Correct answer)
- Congenital cataract
Correct answer: Retinoblastoma
Retinoblastoma is a life-threatening intraocular malignancy and must be excluded first in any child with leukocoria.
Question 4: Pigment epithelial detachment (PED) in age-related macular degeneration is best characterized on OCT as:
- Intraretinal fluid between photoreceptors
- Subretinal fluid under the neurosensory retina
- Dome-shaped elevation of the RPE off Bruch's membrane (Correct answer)
- Full-thickness defect through all retinal layers
Correct answer: Dome-shaped elevation of the RPE off Bruch's membrane
PED appears on OCT as a dome-shaped elevation of the RPE layer separated from Bruch's membrane by fluid or fibrovascular tissue.
Question 5: Anterior ischemic optic neuropathy (AION) in a patient over 60 with jaw claudication and elevated ESR most suggests which underlying etiology?
- Idiopathic (non-arteritic)
- Giant cell arteritis (Correct answer)
- Diabetes mellitus
- Hypertension
Correct answer: Giant cell arteritis
Jaw claudication and elevated ESR in an elderly patient with AION strongly indicate giant cell (temporal) arteritis, a medical emergency.
Question 6: Which type of cataract is most characteristically associated with long-term systemic corticosteroid use?
- Nuclear sclerotic cataract
- Posterior subcapsular cataract (Correct answer)
- Anterior subcapsular cataract
- Cortical spoke cataract
Correct answer: Posterior subcapsular cataract
Posterior subcapsular cataracts (PSC) are the classic steroid-induced and radiation-induced cataract type.
Question 7: A patient with HLA-B27 positivity, low back pain, and recurrent unilateral anterior uveitis with hypopyon most likely has which systemic condition?
- Sarcoidosis
- Ankylosing spondylitis (Correct answer)
- Behçet disease
- Juvenile idiopathic arthritis
Correct answer: Ankylosing spondylitis
Ankylosing spondylitis is strongly associated with HLA-B27 and causes acute recurrent unilateral anterior uveitis.
ABO Ocular Disease & Pathology 3
A 70-year-old diabetic patient presents with new vessels at the disc (NVD) and vitreous hemorrhage.
According to ETDRS criteria, this represents which stage of diabetic retinopathy?