Neuro-ophthalmology Flashcards
A lesion in diencephalon will present with which nystagmus type?
● A. See-saw
● B. Convergence
● C. Retractorius
● D. Downbeat
● E. Upbeat
A. See-saw
Brun’s nystagmus is associated with lesion in which of the following?
● A. Medial longitudinal fasciculus
● B. Lateral longitudinal fasciculus
● C. Pontomedullary junction
● D. Midbrain tegmentum
● E. Medulla
C. Pontomedullary junction
Low degree of papilledema with elevation of nasal margin, 360-degree disk swelling (circumferential halo) but no obscuration of major vessels on fundoscopy characterize which modified Frisen grade papilledema?
● A. Grade I
● B. Grade II
● C. Grade III
● D. Grade IV
● E. Grade V
B. Grade II
Homonymous superior quadrantanopsia in the contralateral visual field (“pie in the sky” deficit) is caused by lesion of which of the following?
● A. Optic tract
● B. Optic chiasma
● C. Meyer’s loop
● D. Optic radiation
● E. Occipital cortex
C. Meyer’s loop
Aneurysm of which of the following most commonly
presents with third nerve palsy?
● A. A comm
● B. P comm
● C. ACA
● D. MCA trifurcation
● E. DACA
B. P comm
Which of the following is not a part of complete Horner syndrome?
● A. Miosis
● B. Ptosis
● C. Enophthalmos
● D. Hyperemia of internal ear
● E. Anhidrosis of half of face
D. Hyperemia of internal ear
What is the most common cause of bilateral internuclear ophthalmoplegia in young adults?
● A. Ocular tuberculosis
● B. Herpes zoster
● C. Congenital
● D. Multiple sclerosis
● E. Horner syndrome
D. Multiple sclerosis
Which of the following is not a cause of pupil-sparing oculomotor palsy?
● A. Uncal herniation
● B. Diabetic neuropathy
● C. Atherosclerosis
● D. Giant cell arteritis
● E. Myasthenia gravis
A. Uncal herniation
Which of the following nerves is not involved in superior orbital fissure syndrome?
● A. III
● B. IV
● C. V1
● D. V2
● E. VI
D. V2
Mastoiditis with involvement of petrous apex presenting with classic triad of abducens palsy, retro-orbital pain, and draining ear is which of the following?
● A. Raeder’s neuralgia
● B. Tolosa Hunt syndrome
● C. Gradenigo’s syndrome
● D. Orbital apex syndrome
● E. Inferior orbital fissure syndrome
C. Gradenigo’s syndrome
Nystagmus is involuntary rhythmic oscillations of the eyes, usually conjugate, most common form of which is jerk nystagmus in which the direction of the nystagmus is defined by the direction of the fast component. A patient with structural lesion in the posterior fossa at the cervicomedullary junction including Chiari malformation type 1, basilar impression, basilar impression, or syringobulbia has which type of nystagmus?
● A. Upbeat nystagmus
● B. Vestibular nystagmus
● C. Downbeat nystagmus
● D. See-saw nystagmus
● E. Convergence nystagmus
C. Downbeat nystagmus
Papilledema also known as choked optic is optic disk swelling caused by increased intracranial pressure (ICP). Elevated ICP is transmitted through the subarachnoid space of the optic nerve sheath to the region of the optic disk which causes axoplasmic stasis and papilledema. How long it typically takes to
develop papilledema after development of a sustained rise in ICP?
● A. 6 to 24 hours
● B. > 6 hours
● C. 12 to 24 hours
● D. 24 to 48 hours
● E. 48 to 72 hours
D. 24 to 48 hours
Papilledema can cause posterior globe flattening or elevation of the optic nerve head and dilatation of the optic nerve sheath (optic nerve sheath hydrops) which can be demonstrated on MRI or CT brain. Following statements regarding modified Frisen scale for papilledema on fundoscopic examination are correct except?
● A. Grade 0 is normal optic disk with minimal swelling of nasal margin, nerve fiber layer is clear, vessels are not obscured, and cup is also not obscured
● B. Grade 1 is minimal papilledema with 230-degree C-shaped swelling of nasal superior and inferior borders with normal temporal margin, and cup, if present, is maintained
● C. Grade 2 is low degree of papilledema with elevation of nasal margin, 360-degree disk swelling, and obscuration of major vessel starting from margins of disk
● D. Grade 3 is moderate degree of papilledema with elevation of entire disk, 360-degree disk swelling, obscuration of greater than or equal to 1 segment of major blood vessel at disk margin, and cup may be obscured
● E. Grade 4 is marked degree of papilledema with nerve fiber layer opaque, 360-degree disk swelling. Vessels obscured at disk margin, not completely obscured at disk surface
C. Grade 2 is low degree of papilledema with elevation of nasal margin, 360-degree disk swelling, and obscuration of major vessel starting from margins of disk
Which of the following is not an etiology of unilateral papilledema?
● A. Compressive lesions like intraorbital meningiomas, optic nerve sheath schwannoma, or optic nerve glioma
● B. Local inflammatory disorders
● C. Foster Kennedy syndrome
● D. Demyelinating disease such as multiple sclerosis
● E. Elevated ICP due to frontal lobe glioma
E. Elevated ICP due to frontal lobe glioma
The normal eye can detect stimuli as far as 60 degrees superiorly, 70 degrees inferiorly, 60 degrees nasally, and 100 degrees temporally. Confrontational method is a bed side test to
detect any gross peripheral field defect while Humphrey visual field, octopus perimeters, and Goldmann perimetry are more accurate in detecting visual field defect. Which of the following
statements is incorrect?
● A. Optic nerve and knee of Wilbrand injury on one side will cause junctional scotoma of ipsilateral eye (monocular blindness) while superior temporal quadrantanopsia of the same side eye
● B. Injury to optic chiasma causes bitemporal hemianopia
● C. Injury to right optic nerve or optic radiation causes left homonymous hemianopia with macular splitting of the left visual field
● D. Injury to right Meyer’s loop causes homonymous left superior quadrantanopsia with macular sparing of left visual field
● E. Partial lesion of right optic radiation or visual cortex causes left homonymous hemianopsia with macular sparing of left visual field
A. Optic nerve and knee of Wilbrand injury on one side will cause junctional scotoma of ipsilateral eye (monocular blindness) while superior temporal quadrantanopsia of the same side eye
