Conjunctiva and cornea: posterior scleritis on B-scan: 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 · Conjunctiva and cornea: posterior scleritis on B-scan

Sample item

A 40-year-old woman with rheumatoid arthritis has deep boring eye pain worse on movement, blurred vision, mild proptosis and choroidal folds, with a quiet anterior segment. Which B-scan finding supports posterior scleritis?

AHighly reflective calcified mass with acoustic shadowingBFluid in the sub-Tenon space forming a T with the optic nerveCDome-shaped choroidal mass with an excavated baseDFunnel-shaped membrane attached to the optic disc

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

The answer and the reasoning

B. Fluid in the sub-Tenon space forming a T with the optic nerve

In posterior scleritis, B-scan shows a thickened posterior sclera with fluid in the sub-Tenon space, which together with the optic nerve gives the T-sign. A calcified shadowing mass suggests retinoblastoma. A collar-stud choroidal mass suggests melanoma, and a funnel membrane is a retinal detachment.

Option by option

A. Highly reflective calcified mass with acoustic shadowing
A calcified shadowing mass indicates retinoblastoma in a child and does not fit this picture.
B. Fluid in the sub-Tenon space forming a T with the optic nerve (correct)
Correct. Sub-Tenon fluid plus the nerve gives the T-sign of posterior scleritis.
C. Dome-shaped choroidal mass with an excavated base
A mushroom choroidal mass with excavation suggests melanoma, which is painless.
D. Funnel-shaped membrane attached to the optic disc
A funnel-shaped membrane is a total retinal detachment, which does not cause deep pain with folds.

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.

Questions about this Ophthalmology question

What is the answer to this Ophthalmology question?

The best answer is B, Fluid in the sub-Tenon space forming a T with the optic nerve. In posterior scleritis, B-scan shows a thickened posterior sclera with fluid in the sub-Tenon space, which together with the optic nerve gives the T-sign.

Why is "Highly reflective calcified mass with acoustic shadowing" not the answer?

A calcified shadowing mass indicates retinoblastoma in a child and does not fit this picture.

Why is "Dome-shaped choroidal mass with an excavated base" not the answer?

A mushroom choroidal mass with excavation suggests melanoma, which is painless.

Why is "Funnel-shaped membrane attached to the optic disc" not the answer?

A funnel-shaped membrane is a total retinal detachment, which does not cause deep pain with folds.

What concept does this question test?

It tests Conjunctiva and cornea: posterior scleritis on B-scan in Ophthalmology. A calcified shadowing mass suggests retinoblastoma. A collar-stud choroidal mass suggests melanoma, and a funnel membrane is a retinal detachment.

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 Conjunctiva and cornea: posterior scleritis on B-scan?

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.