Lect 10 optic neuropathies 1 Flashcards
Which one of the following is NOT an etiology for optic nerve shunts/collaterals?
a) chronic glaucoma
b) uncontrolled diabetes mellitus
c) CRVO
d) optic nerve sheath meningioma
b) uncontrolled diabetes mellitus
Which one of the following is not a sign of optic nerve dysfunction?
a) VA loss
b) RAPD
c) normal VEP
d) dyscromatopsia
e) reduced contrast sensitivity
f) VF defect
c) normal VEP (false, an abnormal VEP is a sign of optic nerve dysfunction)
Which one of the following is NOT true?
a) Typical optic neuritis is caused from demylenation (such as MS)
b) Atypical optic neuritis is caused from systemic infectious/inflammatory causes
c) There is pain associated with both typical and atypical optic neuritis
d) Typical is unilateral and atypical is bilateral
c) There is pain associated with both typical and atypical optic neuritis (FALSE, pain with typical only, no pain with atypical)
The most common visual field abnormalities associated with optic neuritis is:
a) central/centrocecal
b) diffuse
c) altudinal/arcuate/nasal step
d) other
b) diffuse=48%
central/centrocecal=8%
altitudinal/arcuate/nasal step=20%
other=16%
Match the following:
1) Typical optic neuritis
2) Atypical optic neuritis
a) unilateral
b) bilateral
c) painful EOM’s
d) no associated pain
e) age less than 18 or more than 50 yrs old
f) age 15-20 (avg age 32)
g) lab work unnecessary
h) requires blood work
1) Typical optic neuritis
a) unilateral
c) painful EOM’s
f) age 15-20 (avg age 32)
g) lab work unnecessary
2) Atypical optic neuritis
b) bilateral
d) no associated pain
e) age less than 18 or more than 50 yrs old
h) requires blood work
(other signs of atypical optic neuritis include: retinal exudates/infiltrates, hemorrhages, and severe optic nerve swelling, and anterior/posterior uveitis)
Which one of the following is NOT true regarding Typical optic neuritis?
a) gradual VA loss
b) VA improvement by 1 month
c) dyschromatopsia
d) reduced contrast sensitivity
a) gradual VA loss (FALSE, it is sudden VA loss)
Which one of the following is NOT an associated symptom of Typical optic neuritis?
a) bladder control problems
b) Uthoff’s sign (symptoms worsen with increased body temp)
c) pulfrich phenomenon (swinging pendulum)
d) Lehrmittes’s sign (electric shock from neck to spine)
e) Rudolph’s sign (red nose)
f) numbness in hands
e) Rudolph’s sign (lol, I just made that up)
(T/F) The ONTT (optic neuritis treatment trial) was done with pts who presented with atypical bilateral acute optic neuritis
FALSE, The ONTT (optic neuritis treatment trial) was done with pts who presented with typical unilateral acute optic neuritis
(T/F) The ONTT study compared the effects of the following 3 treatments on pt’s with optic neuritis: IV steroids followed by oral steroids, oral steroids alone, and an oral placebo
true
Which one of the following is NOT correct in regards to the results of the ONTT trial?
a) High dose IV steroids accelerated visual recovery
b) oral steroid treatment alone increased risk of rate of recurrence of optic neuritis
c) Brain MRI’s are not useful in identifying patients who are at higher risk of developing MS
d) IV steroids reduced risk of MS development after initial attack of optic neuritis for 2 years, but no benefit after 2 years
c) Brain MRI’s are not useful in identifying patients who are at higher risk of developing MS (FALSE, they are extremely useful in identifying patients who are at higher risk of developing MS)
(T/F) The purpose of the LONS (longitudinal optic neuritis study) was to perform a 15 year follow up on the ONTT pt’s
True. It was a 15 year overall risk of developing MS after developing optic neuritis.
Which of one the following factors (based on the LONS study) is NOT at higher risk for MS?
a) men
b) Caucasians
c) family history of MS
d) all 3 are at higher risk of developing MS
a) men (FALSE, women have a 75% risk, men had a 25% risk)
Which one of the following is NOT considered a low risk for MS (based on the LONS study)?
a) severe disc selling
b) no pain
c) retinal exudates
d) disc or papillary hemorrhage
e) NLP vision
f) male sex
g) all of the above are low risk factors of developing MS based on the LONS study
g) all of the above are low risk factors of developing MS based on the LONS study.
Which one of the following is the correct protocol for an optic neuritis case?
a) obtain an MRI, treat with oral steroids, refer high risk pt’s to PCP
b) obtain an x-ray, treat with a NSAID such as Naproxen, manage low-risk pts and refer high-risk pt’s to an opthalmologist
c) obtain an MRI, treat with high dose IV steroids followed by oral steroids, refer high risk pts to neurologist
d) obtain a CT scan, treat with IV steroids, refer low and high risk pt’s to their PCP
c) order an MRI, treat with high dose IV steroids followed by oral steroids, refer high risk pts to neurologist
You have a pt who you believe has optic neuritis and you are suspicious of MS, you:
a) send PCP an urgent letter for a stat MRI of the brain and orbits and recommend stat IV steroids followed by oral steroids
b) send PCP a letter for MRI of the brain and orbit to be obtained within 7 days and recommend an NSAID such as Naproxen
c) Send PCP a letter for an X-ray of brain and orbits to be obtained within 30 days and prescribe an antibiotic eyedrop.
d) none of the above
a) send PCP an urgent letter for a stat MRI of the brain and orbits and recommend stat IV steroids followed by oral steroids. (**you request the MRI with and without gadolinum contrast to rule out demyelinating lesions)
(T/F) The CHAMPS (controlled high-risk subjects Avonex MS prevention study had a primary goal of testing whether the medication Avonex reduced risk of CDMS and a secondary goal of analyzing the effects of Avonex on MRI findings
True (CDMS=clinically definite multiple sclerosis)
Which one of the following was NOT a finding of the CHAMPS study?
a) Avonex reduced risk of CDMS by 44%
b) Avonex caused cortical cataracts in 12% of pts
c) Avonex reduced occurrence of new lesions and enlargement of lesions
d) all of the above are correct
b) Avonex caused cortical cataracts in 12% of pts (FALSE, I made this up)
Which one of the following is NOT true regarding Oligoclonal bands?
a) they are also called immunoglobulins
b) when present in CSF, indicates inflammation of the CNS
c) Avonex increases the number of oligoclonal bands in blood serum
d) 79-90% of pts with MS have permanently observable oligoclonal bands
c) Avonex increases the number of oligoclonal bands in blood serum (FALSE, i made that up)
NMO antibodies (NMO IgG) target:
a) aquaporin 4
b) oligoclonal bands
c) histamine
d) CD40 ligands
a) aquaporin 4. (NMO is neuromyelitis optica and causes inflammatory demyelination like MS. NMO antibodies are the nervous system’s main water channel protein)
Match the following disorders with their characteristics:
1) NMO
2) MS
a) damages optic nerve and spinal cord only
b) damages any white matter tract
c) respiratory failure is rare
d) respiratory failure occurs in 30% of these pts
e) attacks are more mild
f) attacks are severe
g) CSF oligoclonal bands present
h) CSF oligoclonal bands absent
i) MRI of brain is normal or non-specific
j) MRI of brain shows multiple lesions
1) NMO
a) damages optic nerve and spinal cord only
d) respiratory failure occurs in 30% of these pts
f) attacks are severe
h) CSF oligoclonal bands absent
i) MRI of brain is normal or non-specific
(80-90% female, frequent coexistance of autoimmune disease 30%, MRI cord with longitudinally extensive central necrotic lesions)
2) MS
b) damages any white matter tract
c) respiratory failure is rare
e) attacks are more mild
g) CSF oligoclonal bands present
j) MRI of brain shows multiple lesions
(60-70% female, rare coexistance of autoimmune disease, MRI cord with multiple small peripheral lesions)
