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Malignant Hypertensive Retinopathy — RACP Adult Medicine MCQ

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ModerateCardiologyMalignant Hypertensive RetinopathyRACP Adult Medicine

A 60-year-old man with malignant hypertension (BP 240/140 mmHg) has fundoscopy showing flame haemorrhages, cotton-wool spots, hard exudates in a macular star pattern, arteriolar narrowing, AV nipping, and bilateral optic disc swelling (papilloedema). What is the most likely fundoscopy diagnosis?

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Correct answer: C — Papilloedema

Flame haemorrhages, cotton-wool spots, macular star (hard exudates), and bilateral papilloedema in the setting of severely elevated BP is malignant hypertensive retinopathy (Keith-Wagener-Barker Grade IV). The papilloedema indicates end-organ damage. This is a hypertensive emergency requiring controlled BP reduction in ICU (target 25% reduction in MAP over first hour). Grade III lacks papilloedema.

Reference: eTG Cardiovascular – 2024 – Hypertensive Emergency; RANZCO 2024