Chapter 1 ONH/Neuro

Question 1

Horner’s triad

Answer 1

Miotic pupil, ptosis, anhydrosis

Question 2

Dx Horner’s

Answer 2

topical cocaine drops (should have no effect on pupil)

Question 3

Cause of Horner’s

Answer 3

Damage to Sympathetic pathway, Pre or post ganglionic lesion, Pancoast tumor on apex of lung

Question 4

Adie’s pupil symptoms

Answer 4

acute dilated pupil, women, decreased accommodation, diminished deep tendon reflexes

Question 5

Adie’s pupil dx

Answer 5

.125 pilocarpine

Question 6

Cause of Adie’s

Answer 6

Idiopathic lesion in the ciliary ganglion or the ciliary nerves

Question 7

CN III palsy

Answer 7

eye directed down and out, ipsilateral ptosis, microvascular infarcts, trauma and aneurysms

Question 8

Idiopathic intracranial hypertension

Answer 8

Pseudo tumor cerebri

Question 9

Pseudo tumor cerebri

Answer 9

women, obese, birth control, Number one symptom HA, nausea, transient vision loss

Question 10

Optic disc drusen

Answer 10

Hyaline bodies, hereditary, bilateral, hyper-reflective on B scan

Question 11

Malignant hypertension

Answer 11

> 220/120 mmHg

Question 12

Papilledema

Answer 12

Bilateral disc edema due to increased intracranial pressure

Question 13

Normal lumbar puncture finding

Answer 13

<200 in patient with normal weight

<250 in obese patient

Question 14

Papillitis

Answer 14

Secondary to optic neuritis results in unilateral disc edema

Question 15

Papillitis symptoms

Answer 15

Pain on eye movements (90%), unilateral

Question 16

Arteritic AAION

Answer 16

Occurs secondary to occlusion of the spc arteries due to giant cell arteritis

Question 17

Arteritic AAION symptoms

Answer 17

> 55 years, unilateral disc edema, decreased vision, temporal HA, jaw pain

Question 18

SVP (spontaneous venous pulse)

Answer 18

10-20% of normal population do not have SVP

If you see swollen discs and see a (+) SVP then it is NOT papilledema

Question 19

CAI’s

Answer 19

Diamox, acetazolamide, methazolamide (decreases production of CSF to decrease intracranial pressure)
If allergic to Sulfa can’t take so take Lasix

Question 20

If allergic to Sulfa don’t take ______________

Answer 20

CAI’s

Question 21

If inflammation of ONH is located in the anterior 1/3 of the ONH (unilaterally) you will see the disc edema and this is called ___________.

Answer 21

Papillitis

Question 22

If the inflammation of the ONH is located in the posterior 2/3 of the ONH you won’t see it on exam however the ONH will perform poorly (+APD, poor vision) and is called ____________.

Answer 22

Retrobulbar Optic Neuritis

Question 23

Optic neuritis

Answer 23

women, unilateral, pain on eye movement (90% if time), young, APD, + red cap test

Question 24

Hertel exophthalmometry norms for adults:

Answer 24

Caucasian: 12-22mm
Asian: 12-18mm
African Americans: 12-24mm

Question 25

Von Graefe’s sign

Answer 25

Upper eyelid lag during downgaze

Question 26

Lagophthalmos

Answer 26

Inability to completely close the eyes associated with Graves

Question 27

Verapamil

Answer 27

Used for HTN, angina, and cardiac arrhythmias

Question 28

Arteritic AAION (Giant cell arteritis signs)

Answer 28

jaw pain, anorexia, scalp tenderness, headache temporally,

Question 29

Arteritic AAION needs to treated immediately with what and why?

Answer 29

IV steroids tapered to oral steroids 3-6 months because risk of opposite eye being affected is very high

Question 30

What are normal ESR rates for men and women?

Answer 30

Men age/2

Women age + 10/2

Question 31

Non Arteritic anterior ischemic neuropathy (NAION)

Answer 31

ischemia of ONH due to unknown etiology. Hx of HTN, diabetes, high cholesterol and small c/d ratio, normal ESR.

Question 32

What causes AAION?

Answer 32

Occlusion of SPCA due to giant cell arteritis (temporal arteritis)

Question 33

Ocular myasthenia

Answer 33

Autoimmune, affects young women and older men, diplopia, worse at end of day, ptosis. Tensilon test (decreases ptosis), chest x-ray and thyroid testing.

Question 34

Pituitary Adenoma

Answer 34

Lesion at the optic chiasm: bitemporal hemianopsia: May be hormone secreting: amenorrhea, glactorrhea.

Question 35

Parietal lobe lesion (where is field loss)

Answer 35

homonymous inferior quadranopsia (pie on the floor)

Question 36

Temporal lobe lesion (where is field loss)

Answer 36

homonymous superior quadranopsia (pie in the sky)

Question 37

PITS

Answer 37

Parietal = Inferior Temporal = Superior

Question 38

Homonymous visual field defects only occur at pre or post chiasm?

Answer 38

Post chiasmal