ABO Ocular Disease & Pathology 4 — Questions and Answers
Question 1: In a patient with type 2 diabetes, which finding in the posterior pole requires immediate referral for vitreoretinal evaluation?
- Microaneurysms only
- Hard exudates outside the macula
- Tractional retinal detachment threatening the macula (Correct answer)
- One or two dot-blot hemorrhages
Correct answer: Tractional retinal detachment threatening the macula
Tractional retinal detachment threatening or involving the macula requires urgent vitreoretinal surgical consultation.
Question 2: Keratoconus most characteristically causes which type of astigmatism?
- Regular with-the-rule astigmatism
- Regular against-the-rule astigmatism
- Irregular astigmatism (Correct answer)
- Oblique regular astigmatism
Correct answer: Irregular astigmatism
Keratoconus produces irregular corneal ectasia that cannot be corrected with spectacle lenses, requiring rigid contact lenses or surgery.
Question 3: Which pattern of visual field loss is most consistent with a lesion at the optic chiasm?
- Monocular scotoma
- Homonymous hemianopia
- Bitemporal hemianopia (Correct answer)
- Altitudinal defect
Correct answer: Bitemporal hemianopia
Chiasmal compression (often by a pituitary adenoma) damages crossing nasal fibers, producing bitemporal hemianopia.
Question 4: A 35-year-old Black American presents with bilateral hilar adenopathy, anterior uveitis with mutton-fat KP, and elevated serum ACE. The most likely diagnosis is:
- Tuberculosis
- Sarcoidosis (Correct answer)
- Sympathetic ophthalmia
- Vogt-Koyanagi-Harada disease
Correct answer: Sarcoidosis
Sarcoidosis classically presents with bilateral hilar adenopathy, elevated ACE, and granulomatous anterior uveitis with mutton-fat KP.
Question 5: Subretinal fluid that shifts with positioning and no retinal break characterizes which type of retinal detachment?
- Rhegmatogenous
- Tractional
- Exudative (serous) (Correct answer)
- Combined tractional-rhegmatogenous
Correct answer: Exudative (serous)
Exudative retinal detachments have no break; subretinal fluid accumulates from underlying disease and gravitates with patient position.
Question 6: Which of the following medications is most associated with corneal verticillata (vortex keratopathy)?
- Hydroxychloroquine
- Amiodarone (Correct answer)
- Rifampin
- Ethambutol
Correct answer: Amiodarone
Amiodarone deposits in the corneal epithelium in a whorl-like pattern (verticillata) in virtually all patients taking therapeutic doses.
Question 7: Optic nerve drusen (disc drusen) can mimic papilledema but can be differentiated by:
- Presence of venous pulsations on disc
- Autofluorescence on fundus autofluorescence imaging (Correct answer)
- Normal visual acuity
- Lack of afferent pupillary defect
Correct answer: Autofluorescence on fundus autofluorescence imaging
Disc drusen autofluoresce brightly on fundus autofluorescence (FAF) imaging, distinguishing them from true papilledema.
ABO Ocular Disease & Pathology 4
In a patient with type 2 diabetes, which finding in the posterior pole requires immediate referral for vitreoretinal evaluation?