Hypertensive retinopathy stage 4 features include which of the following?

• A. Attenuation with AV crossing
• B. Cotton-wool spots with hemorrhages
• C. ONH edema, macular star, venous engorgement
• D. Retinal detachment

Answer: (C)

Recognize the hallmark features of malignant hypertensive retinopathy (stage 4): optic nerve head edema (papilledema) with leakage signs such as a macular star from hard exudates and venous engorgement due to severe vascular congestion. The optic disc swelling is the defining feature that elevates this to stage 4, with the macular star indicating macular involvement from leakage around the swollen disc. Previous signs like hemorrhages and cotton-wool spots are typical of earlier stages, but without disc edema you’d be in a lower stage. Retinal detachment is not a characteristic part of hypertensive retinopathy stages.