chapter 16-17-18

Question 1

Which is the most common cause of monocular diplopia?
A. Retinal detachment
B. Lens dislocation
C. Refractive error
D. Conversion reaction

Answer 1

C

Question 2

Head tilt is commonly seen in superior oblique palsy. With right superior oblique palsy, which
type of head tilt is expected?
A. Forward and left
B. Forward and right
C. Backward and left
D. Backward and right

Answer 2

A

Question 3

Which of the following would not be expected to produce vertical diplopia?
A. Superior oblique palsy
B. Myasthenia
C. Thyroid orbitopathy
D. Sixth nerve palsy
E. Third nerve palsy

Answer 3

D

Question 4

What is the purpose of forced ductions?
A. Determine which muscle is weak
B. Determine whether ocular muscle weakness is due to neural defect or neuromuscular
transmission defect
C. Determine whether there is a mechanical restriction of eye muscle action
D. To force a repair of ocular motor dysfunction

Answer 4

C

Question 5

A patient with nystagmus is found to have a paradoxical response to optokinetic testing, where
the fast phase in the direction of movement of the tape. Which is the most likely explanation?
A. Midbrain involvement of multiple sclerosis
B. Congenital nystagmus
C. Wernicke’s encephalopathy
D. Ocular myasthenia

Answer 5

B

Question 6

A patient presents with diplopia which was suddenly noticed. Ocular motor testing shows
defective adduction of the left eye with right lateral gaze. The right eye abducts normally but has
nystagmus with the fast phase to the left. Which is the most likely cause for these findings?
A. Multiple sclerosis
B. Thyroid ophthalmopathy
C. Myasthenia
D. Superior oblique myokymia
E. Lithium intoxication

Answer 6

A

Question 7

For the following questions, select the most likely syndrome from the following list:
A. Congenital nystagmus
B. Spasmus nutans
C. Vestibular nystagmus
D. Downbeat nystagmus
E. Periodic alternating nystagmus
F. Seesaw nystagmus
G. Superior oblique myokymia
H. Gaze-paretic nystagmus

Pendular oscillation in which one eye rises and intorts while the other eye falls and extorts. The
actions alternate.

Answer 7

F

Question 8

For the following questions, select the most likely syndrome from the following list:
A. Congenital nystagmus
B. Spasmus nutans
C. Vestibular nystagmus
D. Downbeat nystagmus
E. Periodic alternating nystagmus
F. Seesaw nystagmus
G. Superior oblique myokymia
H. Gaze-paretic nystagmus
A 2-year-old is brought in for evaluation of titubation and is found to have torticollis plus a highfrequency pendular nystagmus.

Answer 8

B

Question 9

For the following questions, select the most likely syndrome from the following list:
A. Congenital nystagmus
B. Spasmus nutans
C. Vestibular nystagmus
D. Downbeat nystagmus
E. Periodic alternating nystagmus
F. Seesaw nystagmus
G. Superior oblique myokymia
H. Gaze-paretic nystagmus

A 30-year-old man presents with no nystagmus in the primary position but has symmetrical
nystagmus with gaze to either side. It has a jerk appearance with the fast phase in the direction of
gaze.

Answer 9

H

Question 10

For the following questions, select the most likely syndrome from the following list:
A. Congenital nystagmus
B. Spasmus nutans
C. Vestibular nystagmus
D. Downbeat nystagmus
E. Periodic alternating nystagmus
F. Seesaw nystagmus
G. Superior oblique myokymia
H. Gaze-paretic nystagmus
Horizontal jerk nystagmus with a fast phase which changes direction after 1-2 minutes.

Answer 10

E

Question 11

Which of the following are features of light-near dissociation?
A. Pupils constrict to light but dilate with near stimuli
B. Pupils have limited constriction to light, but constrict better to near stimuli
C. Pupils have dilation to light but constriction to near stimuli
D. Pupils dilate in response to light and dilate to near stimuli

Answer 11

B

Question 12

Which of the following are potential causes for irregular pupils?
A. Syphilis
B. Degenerative disease of the iris
C. Midbrain lesions
D. Posterior synechiae
E. All of the above

Answer 12

E

Question 13

Hippus is oscillation in pupillary diameter with steady illumination of the eye. Which of the
following statements concerning interpretation is true?
A. Hippus indicates a defect in retinal transduction, with variable stimulation of midbrain
pathways
B. Hippus is normal variation in pupillary diameter and does not indicate pathology
C. Hippus is due to defective iris contraction resulting from partial denervation
D. Hippus indicates a defect in optic nerve transmission to the lateral geniculate

Answer 13

B

Question 14

A patient presents with marked anisocoria with the left eye dilated and unresponsive to light. The
dilated pupil does not constrict to convergence, either. There are no other ocular motor deficits,
and the right eye dilates and constricts normally to stimuli. The dilated pupil does not constrict to
pilocarpine at 0.05% or 1 %. What is the most likely diagnosis?
A. Third nerve palsy
B. Demyelinating disease
C. Horner’s syndrome
D. Pharmacologic dilation of the pupil
E. Simple anisocoria

Answer 14

D

Question 15

A patient presents with anisocoria with the right pupil smaller than the left. There appears to be
mild ptosis on the right. There are no other ocular motor abnormalities and no other deficits.
Which is the most likely diagnosis and what might be done to confirm the diagnosis?
A. The patient has Horner’s syndrome which can be confirmed by failure of response to cocaine
administration
B. The patient has Horner’s syndrome which can be confirmed by constriction to 0.05%
pilocarpine administration
C. The patient has tonic pupil which can be confirmed by constriction to 0.05% pilocarpine
D. The patient has tonic pupil which can be confirmed by constriction to 1% pilocarpine

Answer 15

A

Question 16

Figure 17-1 shows a series of pupillary responses to light, as labeled.
What type of response is demonstrated here?
A. Tonic pupil on the left side
B. Simple anisocoria
C. Horner’s syndrome on the-right side
D. Partial third nerve palsy on the left side

Answer 16

A

Question 17

Which of the following statements regarding tertiary syphilis is true?
A. The Venereal Disease Research Laboratory test is preferable to the fluorescent treponemal
antibody absorption test for diagnosis of tertiary syphilis
B. Patients with bilateral tonic pupils should be screened for syphilis
C. Horner’s syndrome is the most common ocular manifestation of syphilis
D. All are true

Answer 17

B

Question 18

Which is the most likely cause of lid retraction?
A. Diabetes
B. Orbital tumors
C. Hypothyroidism
D. Hyperthyroidism

Answer 18

D

Question 19

Which of the following are causes of excessive lid closure'/
A. Blepharospasm
B. Apraxia of lid opening
C. Hemifacial spasm
D. Myokymia
E. All of these

Answer 19

E

Question 20

Which of the following are potential causes of insufficient lid closure?
1. Proptosis
2. Parkinsonism
3. Facial nerve palsy
4. Myotonic dystrophy
Select: A = 1,2,3. B = 1,3. C = 2,4. D = 4 only. E = All

Answer 20

E

Question 21

Which of the following statements is true regarding post-traumatic vertigo?
1. Prognosis is usually good
2. Onset is always at the tune of the injury
3. Most patients respond to exercise therapy
4. Long-term post-traumatic vertigo does not occur
Select: A = 1,2,3. B = 1,3. C = 2,4. D = 4 only. E = All

Answer 21

B

Question 22

Drug toxicity is an important cause of vestibulopathy. Which of the following statements are true
about drug-induced vestibulopathy?
1. Streptomycin and gentamycin have greater vestibulotoxic effects than other drugs of the class
2. Risk of aminoglycoside vestibulopathy is increased with renal failure
3. Patients have clinical findings of bilateral dysfunction
4. Patients have examination findings of vestibulopathy but seldom have neurologic deficit
Select: A = 1,2,3. B = 1,3. C = 2,4. D = 4 only. E = All

Answer 22

A

Question 23

Brainstem ischemia is an occasional cause of vertigo. Which of the following statements are true
regarding cerebrovascular disease and vertigo?
1. Isolated vertigo is never due to ischemic disease
2. Patients with brainstem ischemia usually have other signs of brainstem dysfunction
3. Unidirectional nystagmus suggests brainstem ischemia whereas with peripheral vestibulopathy
fast phase of the nystagmus is in the direction of gaze
4. Sudden hearing loss with dizziness suggests infarction in the distribution of internal auditory
artery
Select: A = 1,2,3. B = 1,3. C = 2,4. D = 4 only. E = All

Answer 23

C

Question 24

A 40-year-old man presents with episodes of severe vertigo and vomiting, associated with
tinnitus, fluctuating hearing loss, and a pressure sensation in the ear. Which is the most likely
diagnosis?
A. Acoustic neuroma
B. Meniere’s disease
C. Brainstem infarction
D. Toxic vestibulopathy

Answer 24

B

Question 25

Which of the following statements regarding seizures and vertigo is true?
A. Vertigo with epilepsy is usually of temporal lobe origin
B. Most patients have other associated findings of seizures
C. Seizures are a rare cause of vertigo
D. Dizziness can be an aura of a seizure
E. All of the above

Answer 25

E

Question 26

Migraine-type headache with vertigo indicates brainstem ischemia and is a warning sign of
impending basilar thrombosis,
T. True F. False

Answer 26

F

Question 27

Hypotension with vertigo indicates bilateral vertebral or basilar artery occlusive disease.
T. True F. False

Answer 27

F

Question 28

Benign paroxysmal positional vertigo is suggested by episodic vertigo induced by certain head
positions, with a history of either labyrinthitis with a UR1 or head injury.
T. True P. False

Answer 28

T

Question 29

In differentiation of peripheral positional vertigo from central causes of positional vertigo, which
of the following statements are true?
1. Peripheral vertigo exhibits fatigability whereas central vertigo does not
2. Peripheral vertigo has a shorter latency
3. Peripheral vertigo has a shorter duration
4. Peripheral vertigo is usually less severe than central vertigo
Select: A = 1, 2, 3. B = 1, 3. C = 2, 4. D = 4 only. E = All

Answer 29

B