FREE ABO Retina and Vitreous Disorders Questions and Answers

Question 1

A 68-year-old male with a history of poorly controlled type 2 diabetes presents with a sudden, painless floater in his right eye. Fundus examination reveals neovascularization of the disc (NVD) greater than 1/3 disc area and a mild vitreous hemorrhage. According to the Diabetic Retinopathy Study (DRS), what is the most appropriate next step in management?

Accepted Answer

Prompt panretinal photocoagulation (PRP).

Answer

The patient presents with high-risk characteristics (HRCs) of proliferative diabetic retinopathy (PDR), specifically NVD greater than 1/3 disc area and an associated vitreous hemorrhage. The landmark Diabetic Retinopathy Study (DRS) demonstrated that prompt panretinal photocoagulation (PRP) reduces the risk of severe vision loss by over 50% in eyes with HRCs. While anti-VEGF is also a treatment for PDR, PRP is the established gold standard based on the DRS findings for high-risk disease. Observation is inappropriate given the high risk of progression, and focal laser is for macular edema, not PDR.

Question 2

A 75-year-old female reports gradual blurring of her central vision and difficulty reading. Optical coherence tomography (OCT) reveals large, soft drusen and retinal pigment epithelium (RPE) atrophy. A fluorescein angiogram (FA) is performed. Which of the following FA findings would be most consistent with a diagnosis of neovascular (wet) age-related macular degeneration (AMD) rather than the non-neovascular (dry) form?

Accepted Answer

Early hyperfluorescence with late leakage from an undefined source.

Answer

Early hyperfluorescence that increases in intensity and spreads into the surrounding tissue (leakage) in the late phases of the angiogram is the hallmark of choroidal neovascularization (CNV), the defining feature of wet AMD. Window defects, blocking, and drusen staining are characteristic findings of dry AMD, representing RPE atrophy, pigment, and altered Bruch's membrane, respectively, but not active leakage from new vessels.

Question 3

Which of the following is considered the strongest predisposing risk factor for the development of a rhegmatogenous retinal detachment (RRD)?

Accepted Answer

Posterior vitreous detachment (PVD).

Answer

While high myopia, lattice degeneration, and trauma are all significant risk factors for RRD, the inciting event for the vast majority of RRDs is a posterior vitreous detachment (PVD). The dynamic vitreoretinal traction created during a PVD is what causes the retinal break (the 'rhegma'), allowing liquefied vitreous to enter the subretinal space. The other factors increase the likelihood that a PVD will result in a retinal break and subsequent detachment.

Question 4

A 65-year-old man presents to the emergency department with a 2-hour history of sudden, profound, and painless vision loss in his left eye. His visual acuity is hand motion. Fundus examination reveals diffuse retinal whitening, arteriolar attenuation, and a prominent 'cherry-red spot' in the macula. What is the most critical immediate step in this patient's management?

Accepted Answer

Immediate referral for a comprehensive stroke workup.

Answer

The patient's presentation is classic for a central retinal artery occlusion (CRAO), which is considered an ocular emergency analogous to an acute ischemic stroke. Immediate referral to a stroke center for evaluation is critical to identify the embolic source and reduce the high risk of a subsequent, potentially fatal, cerebral or myocardial infarction. While treatments like paracentesis or ocular massage exist to dislodge the embolus, their efficacy is debated and secondary to the systemic evaluation. Steroids are for arteritic causes (like GCA), which must be evaluated but the stroke workup is the priority for all patients. Vitrectomy has no role in acute CRAO management.

Question 5

A 45-year-old patient is diagnosed with retinitis pigmentosa (RP). Which of the following findings constitutes the classic clinical triad observed on funduscopic examination for this condition?

Accepted Answer

Arteriolar attenuation, waxy optic disc pallor, and bone-spicule pigmentation.

Answer

The classic funduscopic triad of retinitis pigmentosa (RP) consists of retinal arteriolar attenuation, a waxy appearance of the optic disc pallor, and characteristic mid-peripheral intraretinal pigment migration in a bone-spicule pattern. The other answer choices describe findings associated with different retinal pathologies: option A can be seen in various conditions, option B suggests uveitis or a choroidal mass, and option D is characteristic of diabetic retinopathy.

ABO - American Board of Ophthalmology Practice Test

ABO - American Board of Ophthalmology Practice Test

FREE ABO Retina and Vitreous Disorders Questions and Answers