Retina: retinal haemorrhages in abusive head trauma: 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 · Retina: retinal haemorrhages in abusive head trauma

Sample item

A 4-month-old infant is brought unconscious with subdural haemorrhage and no history of trauma. The ophthalmologist finds extensive multilayer retinal haemorrhages extending to the periphery. What is the most likely cause?

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

The answer and the reasoning

C. Abusive head trauma

Extensive multilayered retinal haemorrhages with subdural haematoma in an infant raise strong suspicion of abusive head trauma, from repeated acceleration-deceleration forces. Birth haemorrhages clear within about six weeks. A child protection assessment is needed.

Option by option

  • A. Retinopathy of prematurity

    ROP follows prematurity and shows vascular changes at the avascular retina edge, not haemorrhages.

  • B. Normal birth-related findings

    Birth haemorrhages are mostly gone by six weeks, so they do not explain this at four months.

  • C. Abusive head trauma (correct)

    Correct. Widespread multilayer haemorrhages with subdural blood suggest shaking injury.

  • D. Congenital rubella

    Congenital rubella gives cataract and salt-and-pepper retinopathy.

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 C, Abusive head trauma. Extensive multilayered retinal haemorrhages with subdural haematoma in an infant raise strong suspicion of abusive head trauma, from repeated acceleration-deceleration forces.

Why is "Retinopathy of prematurity" not the answer?

ROP follows prematurity and shows vascular changes at the avascular retina edge, not haemorrhages.

Why is "Normal birth-related findings" not the answer?

Birth haemorrhages are mostly gone by six weeks, so they do not explain this at four months.

Why is "Congenital rubella" not the answer?

Congenital rubella gives cataract and salt-and-pepper retinopathy.

What concept does this question test?

It tests Retina: retinal haemorrhages in abusive head trauma in Ophthalmology. Birth haemorrhages clear within about six weeks. A child protection assessment is needed.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. 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 Retina: retinal haemorrhages in abusive head trauma?

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.