Retina: hypertensive retinopathy: 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: hypertensive retinopathy

Sample item

A 50-year-old man with severe hypertension has fundus findings of flame-shaped haemorrhages, cotton-wool spots and swelling of the optic disc. How is this graded in the Keith-Wagener-Barker classification?

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

The answer and the reasoning

C. Grade IV (malignant hypertensive retinopathy)

In the classical grading, grade I is mild arteriolar narrowing, grade II adds arteriovenous crossing changes, grade III adds haemorrhages, exudates and cotton-wool spots, and grade IV adds papilloedema (disc swelling). Disc oedema indicates malignant hypertension, a medical emergency needing controlled reduction of blood pressure.

Option by option

  • A. Grade I

    Grade I is only mild generalised arteriolar narrowing.

  • B. Grade III only

    Grade III has haemorrhages and exudates but no disc swelling.

  • C. Grade IV (malignant hypertensive retinopathy) (correct)

    Correct. Papilloedema marks grade IV, malignant hypertension.

  • D. Grade II

    Grade II adds arteriovenous nicking without haemorrhages.

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, Grade IV (malignant hypertensive retinopathy). In the classical grading, grade I is mild arteriolar narrowing, grade II adds arteriovenous crossing changes, grade III adds haemorrhages, exudates and cotton-wool spots, and grade IV adds papilloedema (disc swelling).

Why is "Grade I" not the answer?

Grade I is only mild generalised arteriolar narrowing.

Why is "Grade III only" not the answer?

Grade III has haemorrhages and exudates but no disc swelling.

Why is "Grade II" not the answer?

Grade II adds arteriovenous nicking without haemorrhages.

What concept does this question test?

It tests Retina: hypertensive retinopathy in Ophthalmology. Disc oedema indicates malignant hypertension, a medical emergency needing controlled reduction of blood pressure.

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 Retina: hypertensive retinopathy?

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.