Retina: Valsalva 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: Valsalva retinopathy

Sample item

A 28-year-old woman develops sudden painless blurring of the central vision while lifting a heavy box. Fundus shows a round haemorrhage with a flat level at its lower edge in front of the macula. What is the likely cause of the bleed?

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

The answer and the reasoning

B. A sudden rise in intrathoracic pressure rupturing superficial macular capillaries

Straining against a closed glottis raises venous pressure abruptly and can rupture superficial retinal capillaries, producing a sub-internal limiting membrane premacular haemorrhage. It often clears over weeks to months, and Nd:YAG laser hyaloidotomy may drain a dense one. The sharp fluid level is a typical clue.

Option by option

  • A. Neovascular vessels growing from the optic disc

    Disc neovascularisation causes vitreous haemorrhage in proliferative disease and not a premacular pool after straining.

  • B. A sudden rise in intrathoracic pressure rupturing superficial macular capillaries (correct)

    Correct. A Valsalva-type pressure surge ruptures superficial macular capillaries and gives a premacular haemorrhage.

  • C. Rupture of a retinal macroaneurysm in the elderly

    Macroaneurysm rupture typically affects older hypertensive women and not a young woman after lifting.

  • D. Choroidal neovascular membrane under the fovea

    A choroidal neovascular membrane causes subretinal blood with distortion and does not form a level in front of the retina.

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 B, A sudden rise in intrathoracic pressure rupturing superficial macular capillaries. Straining against a closed glottis raises venous pressure abruptly and can rupture superficial retinal capillaries, producing a sub-internal limiting membrane premacular haemorrhage.

Why is "Neovascular vessels growing from the optic disc" not the answer?

Disc neovascularisation causes vitreous haemorrhage in proliferative disease and not a premacular pool after straining.

Why is "Rupture of a retinal macroaneurysm in the elderly" not the answer?

Macroaneurysm rupture typically affects older hypertensive women and not a young woman after lifting.

Why is "Choroidal neovascular membrane under the fovea" not the answer?

A choroidal neovascular membrane causes subretinal blood with distortion and does not form a level in front of the retina.

What concept does this question test?

It tests Retina: Valsalva retinopathy in Ophthalmology. It often clears over weeks to months, and Nd:YAG laser hyaloidotomy may drain a dense one. The sharp fluid level is a typical clue.

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: Valsalva 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.