Retina: pathology of cotton wool spots: 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: pathology of cotton wool spots

Sample item

A patient with severe hypertension has several white, fluffy patches with feathery edges in the posterior pole. What is the underlying pathology of these patches?

ASubretinal fluid in the maculaBInfarction of the nerve fibre layer with stasis of axoplasmic flowCCalcified drusen beneath the pigment epitheliumDLipid exudation from leaking capillaries into the outer plexiform layer

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

The answer and the reasoning

B. Infarction of the nerve fibre layer with stasis of axoplasmic flow

Cotton wool spots are microinfarcts of the superficial nerve fibre layer caused by precapillary arteriolar occlusion. Axoplasmic transport stops, and the swollen axon ends give a white, fluffy look. They are seen in hypertension, diabetes, HIV and lupus.

Option by option

A. Subretinal fluid in the macula
Subretinal fluid causes a serous detachment and does not give a white fluffy patch.
B. Infarction of the nerve fibre layer with stasis of axoplasmic flow (correct)
Correct. Axoplasmic stasis in an infarcted nerve fibre layer produces the fluffy white patch.
C. Calcified drusen beneath the pigment epithelium
Drusen are discrete yellow deposits in the elderly under the RPE.
D. Lipid exudation from leaking capillaries into the outer plexiform layer
Lipid leakage in the outer plexiform layer causes hard exudates, which are sharp and yellow.

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, Infarction of the nerve fibre layer with stasis of axoplasmic flow. Cotton wool spots are microinfarcts of the superficial nerve fibre layer caused by precapillary arteriolar occlusion.

Why is "Subretinal fluid in the macula" not the answer?

Subretinal fluid causes a serous detachment and does not give a white fluffy patch.

Why is "Calcified drusen beneath the pigment epithelium" not the answer?

Drusen are discrete yellow deposits in the elderly under the RPE.

Why is "Lipid exudation from leaking capillaries into the outer plexiform lay…" not the answer?

Lipid leakage in the outer plexiform layer causes hard exudates, which are sharp and yellow.

What concept does this question test?

It tests Retina: pathology of cotton wool spots in Ophthalmology. Axoplasmic transport stops, and the swollen axon ends give a white, fluffy look. They are seen in hypertension, diabetes, HIV and lupus.

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: pathology of cotton wool spots?

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.