Uvea: infectious retinitis: practice question

A Ophthalmology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Ophthalmology · Uvea: infectious retinitis

Sample item

A man with advanced HIV (CD4 count 20 cells/mm3) has painless floaters and loss of peripheral vision. The fundus shows areas of white, necrotic retina with haemorrhages along the vessels, described as 'pizza-pie' appearance. What is the treatment?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Ganciclovir, given intravenously or as an intravitreal injection or implant

Cytomegalovirus retinitis is the commonest opportunistic eye infection in advanced AIDS, causing necrotising retinitis with haemorrhage and exudate along the vascular arcades. Treatment is ganciclovir (systemic, or intravitreal), valganciclovir, foscarnet or cidofovir, together with antiretroviral therapy to restore immunity. Steroids alone would worsen the infection.

Option by option

  • A. Oral amoxicillin

    Amoxicillin has no activity against CMV.

  • B. Intravitreal corticosteroids alone

    Steroids alone suppress immunity and worsen the infection.

  • C. Pyrimethamine and sulfadiazine

    Pyrimethamine and sulfadiazine treat ocular toxoplasmosis, which looks like a focal 'headlight in fog' lesion.

  • D. Ganciclovir, given intravenously or as an intravitreal injection or implant (correct)

    Correct. Antiviral therapy against CMV is required.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Ophthalmology question

What is the answer to this Ophthalmology question?

The best answer is D, Ganciclovir, given intravenously or as an intravitreal injection or implant. Cytomegalovirus retinitis is the commonest opportunistic eye infection in advanced AIDS, causing necrotising retinitis with haemorrhage and exudate along the vascular arcades.

Why is "Oral amoxicillin" not the answer?

Amoxicillin has no activity against CMV.

Why is "Intravitreal corticosteroids alone" not the answer?

Steroids alone suppress immunity and worsen the infection.

Why is "Pyrimethamine and sulfadiazine" not the answer?

Pyrimethamine and sulfadiazine treat ocular toxoplasmosis, which looks like a focal 'headlight in fog' lesion.

What concept does this question test?

It tests Uvea: infectious retinitis in Ophthalmology. Treatment is ganciclovir (systemic, or intravitreal), valganciclovir, foscarnet or cidofovir, together with antiretroviral therapy to restore immunity. Steroids alone would worsen the infection.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Uvea: infectious retinitis?

Group the red eye by what to examine and what the pupil does. Then use the flashcards and the other Ophthalmology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.